How Respiratory Therapists Fit into the Palliative Care Paradigm

Palliative Care Paradigm

The dying process is never easy, and health care professionals trained to do whatever it takes to keep people alive often struggle with the concept. Respiratory therapists, with their laser-like focus on the breath of life, understandably have a hard time letting that breath go.

At the bedside

Angela Reid, RRT-ACCS, works with all types of patients in her job as a therapist at Mercy Health in Youngstown, OH, and is no stranger to palliative care.

“In my experience, if they are vented and we are going to remove the ETT tube generally the RN will get the morphine drip ready and call us once she is ready to start,” Reid said. “We typically ask the family if they want to stay while we do this; however, I always let them know the process so that if they do stay they are not alarmed by any noises or anything.”

She lets family members know their loved ones may not pass as soon as they are taken off life support as well, and assures them someone will remain by their side throughout the process to deliver any medication they may need to keep them comfortable. While clinicians rarely give robinul for secretions, they will if the situation warrants.

A delicate situation

They work hard to make family members as comfortable as possible too.

“We offer them a chapel or priest from our site or their own, and always offer cookies and coffee as well as tissues,” Reid said. “I try to get the vent out of the room as quickly as possible so everyone has room to say their goodbyes.”

When family members choose to be out of the room while she is disconnecting the patient, she will also try to clean the patient up a bit before they come back in so the person will look more like himself.

Lastly, she and her colleagues make it a point to tell the family how sorry they are for their loss.

“I think it’s a delicate situation, one that should be handled with the utmost respect, as you are trying to help this family to realize that despite how difficult this choice is, you are doing the right thing,” Reid said. “It may be hard at times to say difficult words to a family member or members, but I do with my heart and soul and know that one day I will need that support as well with someone I love and care about.”

Learning the ropes

For most RTs like Reid, knowing what to do in palliative care situations is something that has been learned over time and with a lot of experience.

Cheri Bate, MA, RRT, manager of education, respiratory care, and PFT at Indiana University Health Academic Health Center in Indianapolis, is working to ensure therapists in her organization have some training in the area up front.

She just completed a medical ethics fellowship and is now working with the Palliative Care Team to produce a video aimed at ensuring RTs understand the IN-POST form used at Indiana Health.

The POST form is an advance care planning tool that helps ensure treatment preferences are honored and appears as a pop-up in the patient’s electronic medical record to alert the clinician to the patient’s end of life wishes.

Training still evolving

Training is multifaceted and still evolving.

“We have a chaplain come and talk to all of our new hires going into the critical care units and he discusses with them that families of patients that were terminally weaned remember specific details of how the therapist handled everything around this process,” Bate said.

IMPACT ICU, which brings RTs together with nurses and other disciplines for training, is being implemented at one of the system’s hospitals and will eventually roll out in all critical care areas as well.

And the ethics fellowship Bate just completed is open to any respiratory therapist interested in applying. Her session took place over 36 Wednesdays and included everything from seminars and scholarly project sessions to video discussion sessions and required readings.

The biggest challenge for RTs, she says, is finding the time to be there when the family discussion around advance planning is taking place. Therapists are often taking care of other patients and just can’t make the meeting.

Sacred space

Bate believes proper training can help respiratory therapists better cope with their role in palliative care and add special meaning to the process.

“I believe it is very rewarding to be with a patient at the end of their life, to honor their wishes, and to be in that sacred space with them and their families,” Bate said.