Palliative Care Service

Program Director:
Ira Byock, MD

Palliative care addresses each patient as a whole person, including his or her physical comfort, confidence, emotional well-being, spirituality, and dignity. Because family members are also involved in a person’s illness, the palliative care team supports them and helps them feel informed as well. Since no two people are alike, our palliative care team works closely with patients, their loved ones, and their clinicians. Taking into account the patient’s personal values and treatment preferences, together we discuss and create a one-of-a-kind approach that includes what matters most to each individual.

Who Benefits from Palliative Care?

Our palliative care team provides personalized services, resources, and support for patients with a wide range of medical challenges, such as:

• People living with cancer, congestive heart failure, Lou Gehrig’s Disease (ALS), Alzheimer’s Disease, and other life-threatening conditions, as well their loved ones, who have concerns and questions of their own
• Infants and children living with complex medical needs, as well as their parents and siblings
• Frail elders living with the health concerns of aging, as well their spouses and adult children who may assist with their daily care

Patients usually receive palliative care services along with other medical treatments, such as intensive care, cardiac or cancer care, and hospice care. At Norris Cotton Cancer Center and DHMC, palliative care services are available to patients in the hospital as well as to those being treated in clinics. When needed, we work closely with hospice teams in a person’s community to ensure a smooth transition to care in the family’s home or a nearby assisted-living setting.

• Pamphlet about Palliative Care Services and Resources available through the Cancer Center (PDF, 6 pages, 1.9 MB)
• Information about Living Well with Serious Illness (PDF, 8 pages, 2 MB)

Charting Your Course: An Education and Support Handbook to Empower People Living with Advanced Cancer and Their Families

• Charting Your Course Handbook (PDF, 103 pages, 395 KB)

Living with cancer can be both difficult and stressful. Few of us are ready for the hard choices that have to be made. To assist you and your family during these difficult times, we have developed a program to improve symptom management and help with emotional, physical, spiritual, and financial issues. This handbook has information and activities in four major areas:

• Problem-Solving
• Communications & Social Support
• Symptom Management
• Advance Care Planning

There is also an Appendix that contains resources you may find helpful.

This manual was developed through a grant of the National Cancer Institute. It is a project of the ENABLE II Study.

For More Information

If you would like to learn more about Project ENABLE, see:

• Bakitas, M., Stevens, M, Ahles, TA, Kirn, M. Skalla, K, Kane, N. and Greenberg, ER (for Project ENABLE staff). (2004) Project ENABLE: A palliative care demonstration project for advanced cancer patients in 3 settings: One project of the Robert Wood Johnson Foundation's "Promoting Excellence in End-of-life care. Journal of Palliative Medicine 7(2): 363-372. Link
• Bakitas, M, Lyons, K.D., Dixon, J, Ahles, T. (2006) Palliative Care Program Effectiveness Research: Developing rigor in sampling design, conduct and reporting. Journal of Pain and Symptom Management, 31(3): 270-284. Link
• Bakitas, M., Ahles, T, Skalla, K, et al. (2008) Proxy perspectives about end-of-life care for person's with cancer. Cancer. 112(8):1854-1861. Link
• Lyons, K, Bakitas, M, Hegel, et al. (2009) Reliability and validity of the Functional Assessment of Chronic Illness Therapy- Palliative Care (FACIT-Pal) Scale. Journal of Pain and Symptom Management, 37(1): 23-32. Link
• Bakitas, M., Lyons, KD, Hegel, M, Balan, S, Barnett, KN, Brokaw, FC, Byock, IR, Hull, JG, LI, Z., McKinstry, E, Seville, JL & Ahles, T.A. (2009). The Project ENABLE II Randomized Controlled Trial to Improve Palliative Care for Rural Patients with Advanced Cancer: Baseline Findings, Methodological Challenges, and Solutions. Palliative and Supportive Care 7: 75-86. Link

Note: An earlier version of the curriculum with additional materials for healthcare professionals is also available.