Published on September 6, 2019
Not long after Alexander Gamble, MD, medical director of Phelps Health’s Supportive Care program, started his new job in Rolla, he received his first request for a palliative care consultation. In fact, the consult took place on the second day of his orientation week.
Before Dr. Gamble began seeing patients admitted to the hospital, Phil Cox, PhD, pastoral care director at Phelps Health, along with several other healthcare team members, including pharmacy, nursing and therapy staff, were meeting with only a handful of patients each year for palliative care concerns.
Palliative care focuses on a multidisciplinary approach to specialized care for people with serious illnesses.
Cox and the others laid the groundwork for the palliative care consultation service, which has evolved into the Supportive Care program that Dr. Gamble and his team oversee now.
"When I got here (in late 2016), Phil and I started reshaping the program," Dr. Gamble said. "We rebranded it, calling it Supportive Care, and made it more accessible to patients and families."
With the addition of Dr. Gamble, the patient consults now involve input from a physician who specializes in palliative care.
Before Dr. Gamble joined Phelps Health, about five patients were seen per year through the previous consultation program.
Starting in late 2016, "we were seeing a patient about every other day," Dr. Gamble said. By the end of that year, the number of patient consults through this service was 46.
What Is Supportive Care?
Supportive Care is described as a consultation service offered in the hospital that is focused on quality of life issues for patients and families facing serious illnesses, according to Dr. Gamble.
The Phelps Health Supportive Care team is made up of Dr. Gamble and Cox as well as Amber Cook, APRN, FNP-C, ACHPN; Jessica Bland, AGPCNP; and Shana Wisniewski, LCSW, MSW.
Their work primarily consists of helping patients admitted to the hospital with symptom management. Another big part of the Supportive Care team’s job is communication.
"Usually, a lot of information is coming at them [patients], and it’s not always in plain English," Dr. Gamble said. "We can help translate that information into a way they can understand."
Dr. Gamble said if patients are extremely sick, they may see several different doctors and providers. Phelps Health’s Supportive Care team can work with these patients and their families to fill in the gaps and explain how all of the information they receive fits together.
"When we consult with patients, we want to make sure we understand their goals, which are unique and can change over time," Dr. Gamble said. "After we’ve identified the patients’ goals, we want to make sure the care they receive really reflects their wishes."
As nurse practitioners, both Cook and Bland offer nursing and medical perspectives and help patients with managing their symptoms, with identifying their goals, and with understanding their care and treatment options.
"We get to know who our patients are and what their hopes are for their healthcare," Cook said.
As chaplaincy director, Cox attends to patients’ spiritual and religious needs. "I try to find out if our patients have a church connection or a religious background and how their faith is doing," he said.
Patients’ finances, mental health and family dynamics can all have an impact on their health, so as a social worker, Wisniewski assists with trying to meet those needs, too. "We work with the care managers and discuss discharge planning and resources available," she said.
Often their roles overlap. All Supportive Care team members can help patients with advance care planning, such as completing advance directives.
A Growing Need
As more doctors and providers are learning about the service, Supportive Care consults with patients admitted to the hospital have increased.
"We saw that if we are going to continue to provide this service in an effective way, we needed to expand," Dr. Gamble said. In late 2016, Cook was brought on to provide a nursing perspective, and Wisniewski was added in the spring of 2017 as a social worker.
The most recent addition to the team is Bland, who started at Phelps Health in January 2019.
In 2017, Phelps Health Supportive Care team members participated in 311 patient consults. That number increased to 422 in 2018.
"January (2019) was a highest volume of new consults ever," Dr. Gamble said, noting that around 50 patient consults were conducted that month. "It’s been good growth."
Not only is the number of patients served by Supportive Care growing, patients are being seen earlier in their care.
"The first consultations we were doing, very commonly, we were being called at the end of the case -- the day of the patient’s discharge," Dr. Gamble said. Recently, the Supportive Care team was called as soon as the patient was admitted into the Emergency Department.
While Supportive Care remains an inpatient consult service now, Dr. Gamble said he would eventually like to see the program grow out into the community and be offered in an outpatient clinic setting and eventually at patients’ homes.
Meet the Supportive Care Team
Alexander Gamble, MD, is the medical director of the Phelps Health Supportive Care program. Dr. Gamble joined the Phelps Health team in 2016. He is board-certified in internal medicine, psychiatry and palliative medicine.
Phil Cox, PhD, is the pastoral care director at Phelps Health. As part of the Supportive Care team, he provides chaplaincy services to patients and their families.
Amber Cook, APRN, FNP-C, ACHPN, has been employed by Phelps Health since 2013 and joined the Supportive Care team in 2016. She is a board-certified Family Nurse Practitioner and an Advanced Certified Hospice and Palliative Nurse.
Shana Wisniewski, LCSW, MSW, has been with the Phelps Health Supportive Care team since April 2017. In her role, Wisniewski provides social work support to patients and their families.
Jessica Bland, AGPCNP, is the newest member of the Phelps Health Supportive Care team, joining in January 2019. Bland offers a medical perspective and helps patients manage their symptoms.