"Palliative care focuses on relief of suffering and quality of life for patients facing serious life-threatening illness, and for their families, regardless of whether the final outcome is death or cure of the illness," said Christine Ritchie, director of the University of Alabama at Birmingham (UAB) Center for Palliative Care. The Center was created to capture a wealth of expertise, using advanced medical technology and new integrated therapies. Its faculty supports clinical services at UAB and at the Birmingham VA Medical Center. "The mission of the Center is to enhance the evaluation and care of patients with advanced illness and life-limiting or life-threatening disease and to provide clinical education and a research environment," said Rodney Tucker, medical director of UAB's inpatient palliative care programs. Palliative medicine was recognized as a specialty in 2007 by the American Council of Graduate Medical Education and the American Board of Medical Specialists. "Being recognized as a separate specialty ensures future legitimacy and long-term sustainability," said Tucker. Helping patients and their families negotiate medical and quality-of-life issues while dealing with serious health concerns improves their overall care, resulting in fewer visits to emergency rooms and fewer days in the hospital. According to the U.S. Department of Health and Human Services, the most common causes of death in 1900 — pneumonia, tuberculosis and diarrhea and enteritis — were contagious diseases that killed their patients relatively quickly. According to the National Center for Health Statistics, the most common causes of death in 2000 — heart disease, cancer, stroke and emphysema/chronic obstructive pulmonary disease (COPD) — are primarily lifestyle induced and act in a chronic, rather than an acute, fashion. Consequently, from the time of diagnosis, patients and their caregivers sometimes face years of treatments impacting their quality of life. "We assess each patient in a holistic manner by addressing the four domains of suffering: physical, emotional, psychosocial and spiritual. Additionally, some patients are financially burdened by their illness, and we help them coordinate resources," said Tucker. The Center's clinical faculty conducts inpatient consults and tends to patients in the UAB Palliative Care and Comfort Unit, and in the Birmingham VA Safe Harbor Unit directed by Dr. Amos Bailey, founder of Cooper Green Hospital's Balm of Gilead. Two outpatient clinics staffed by a variety of medical personnel from a broad range of disciplines serve patients currently undergoing curative treatment or those who have completed treatment and are considered disease-free. The Supportive Care Clinic primarily treats cancer patients with teams of doctors and nurses specializing in palliative medicine, physical medicine and rehab, internal medicine and nutrition, as well as psychologists and a registered dietician. "Cancer patients account for the largest portion of our patients," said Elizabeth Kvale, medical director of UAB's Outpatient Palliative Care programs. In the Palliative Care Clinic, specialists in palliative medicine, internal medicine, family medicine and psychiatry, as well as those with expertise in symptom management, treat patients with other chronic illnesses such as HIV, emphysema/COPD, heart disease, dementia and Parkinson's disease. There are as many ways to manage a patient's symptoms as there are patients, and each one is evaluated according to their individual needs and abilities. Patients continue their treatment and relationships with their primary care physicians simultaneously with palliative care. Tucker said, "If a patient has been seen for twenty years by one doctor, we want that doctor to see that patient for twenty years and six months, or however long they choose to continue their relationship. Thinking they have to "give-up" their beloved doctor at this stage in their lives can cause a tremendous amount of stress. Knowing they don't have to can alleviate it." The emotional and spiritual suffering endured by patients, as well as their care-givers, can negatively affect their treatment and quality of life. To address these issues and help navigate the maze that is the healthcare system, the UAB Center has a holistic care coordinator who conducts an assessment of each patient's spiritual and community needs and helps coordinate various processes, particularly for cancer patients undergoing treatment or entering hospice. Using a whole-person approach, the coordinator works with patients and their families to help them understand treatment plans and to provide synchronization of supportive care and counseling, spiritual care, financial and social assistance, nutrition guidance and symptom management. "At any point, a patient may need to integrate home health, nursing home care, sitting services or any other necessary component for their treatment. We work with everyone involved to help with the transition," said Tucker. The UAB Center for Palliative Care recently received two prestigious awards. The American Hospital Association recently recognized the Center as one of nine recipients of their 2008 Circle of Life Awards. In a July 21, 2008, press release, AHA president and CEO Rich Umbdenstock said, "The Circle of Life award recognizes organizations that are focused on expanding the frontiers of palliative and end-of-life care, in terms of access and quality. These programs are striving to be there for patients and families every step of the way, with expertise, compassion, and assistance. A focus on choice and dignity helps distinguish these programs and helps serve as a model to others." The Center to Advance Palliative Care awarded the Center status as one of nine Palliative Care Leadership Centers for Training. The recognition qualifies the Center to hold intensive two-day training programs in palliative care for healthcare professionals (two CME credits for physicians), as well as a year-long mentoring program for hospitals wanting to build their own program. Tucker said, "There's a huge gap between what we want and what we receive in advanced illness care. Palliative medicine provides avenues for bridging that gap. There is a better way to take care of patients." Ritchie added, "Our goal is to provide compassionate care that draws on best clinical practices and offers it with respect and dignity to our patients and their loved ones."