Comforting Care – Expert Focuses on End of Life Issues


Dr. VanAken confers with long-time patient Della Horn during a recent hospital stay.

In the late 1980s, as one of the first family physicians to practice at the newly opened VacaValley Hospital, Terrell VanAken, M.D., specialized in treating entire families. “From birth to death, I’d be there through their whole life cycle.”

But, during the next decade, Dr. VanAken found his interest shifting toward patients at their life’s end.

That change led him to help build and develop NorthBay’s unique set of programs that care for Solano County’s chronically and terminally ill patients.

Dr. VanAken became medical director of NorthBay Hospice & Bereavement in 2002, where the goal is to provide compassionate care in a patient’s final months of life. “In my new role, I found I could be much more ‘hands-on’ with my patients, by conducting home visits and spending more time with them and their families.”

The program is unique among others in the area, Dr. VanAken says. “Unlike national, for-profit hospice organizations, or those that serve patients in large geographic areas, our services are for Solano County residents only, and we’re a nonprofit organization. We are, basically, a ‘hometown hospice.’”

But, not all patients can measure time in days or just a few months; others have serious and complicated illnesses they must manage for years. In 2007, recognizing this special need led Dr. VanAken and his team to help develop another program: NorthBay Bridges Supportive Care Service of NorthBay Healthcare, which is a palliative care program.

The program aims to more adequately serve patients with serious and chronic illnesses who are in the last years of their lives, but not necessarily within the last months of their lives.

Palliative care is a growing movement, Dr. VanAken says. Some studies have shown that patients in palliative care report better quality of life, are less depressed, and usually spend fewer days in the hospital or have fewer visits to the emergency room.

Dr. VanAken finds his biggest challenge is in educating people on the difference between hospice and palliative care, because they both start with a similar goal—pain management, symptom control and psychosocial and spiritual support. “But, it’s easy to see that the lines can be blurred,” he concedes, “especially when people ‘Google’ palliative care and the first thing that pops up is ‘hospice.’ Without knowing the subtle differences, it can cause concern.” Hospice is actually the conclusion of ongoing palliative care.

Ask Your Doctor About Palliative Care

  • If you have a progressive, advanced illness, such as cancer, Alzheimer’s disease, HIV/AIDS, Lou Gehrig’s Disease, congestive heart failure, COPD, multiple sclerosis.
  • If you have multiple diseases with complex and significant symptoms.
  • If you have multiple emergency room visits or hospitalizations within a year.
  • If you or your family are uncertain about goals of care.
  • If you need additional support in end-of-life decision making.

Dr. VanAken finds his biggest challenge is in educating people on the difference between hospice and palliative care, because they both start out with a similar goal—pain management, symptom control and psychosocial and spiritual support.

Key Differences Between Hospice Palliative Care

Both hospice and palliative care will provide patients with pain management, symptom control, psychosocial support and spiritual care. But, there are key differences between the two, according to Dr. VanAken.

  • Both hospice and palliative care are available to patients with serious, chronic, and progressive diseases.
  • Hospice is most appropriate for patients with a life expectancy of months, not years. It emphasizes comfort care, rather than a cure.
  • Hospice is most appropriate when you and your family determine that you wish to no longer receive life-prolonging treatment.
  • Patients receiving palliative care may continue to pursue further curative therapies.
  • Palliative care helps patients identify community resources that can assist them with advance care planning, with making decisions about treatment plans, and with managing the physical, emotional and spiritual symptoms of their illness.
  • Hospice services are provided where the patient resides: in their home, or at an assisted living facility, nursing home or hospital.
  • Cancer patients receive palliative care from Symptom Management Service of the NorthBay Cancer Center, which consults with Dr. VanAken.

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