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Barbara Reville, DNP, CRNP is a palliative care nurse practitioner and co-directs the Palliative Care Program at the Hospital of the University of Pennsylvania (HUP) with Michael Ashburn, MD, MPH, a pain medicine specialist and palliative care physician.

Penn Medicine offers consultation with palliative care professionals for hospitalized patients and an outpatient clinic at both the Perelman Center for Advanced Medicine and the Penn Pain Medicine Center. Partners at Penn’s Home Care & Hospice Services provide home-based palliative and hospice care.

Life takes on new meaning when you receive a cancer diagnosis. Doctor appointments, therapy dates and uncomfortable or painful symptoms derail your daily routines of family, work and leisure. Now you have worries about medical decisions and concerns about an uncertain future. Even with top medical care, outstanding nursing support and your family at your side, these are trying times.

Palliative care is a medical specialty focused on relieving pain and other symptoms, and helping patients and families navigate difficult medical decisions. When life gets distressing, palliative care can provide an extra layer of support. Effective symptom management is necessary for many patients coping with serious illness, regardless of the diagnosis or stage of disease. Most hospitals in the United States have a palliative care program, either as a consultation service in the hospital or access to professionals in the outpatient area.

Many people confuse palliative care with hospice care. While they both focus on symptom management, they are not the same. Palliative care supports patients with unacceptable pain, symptoms, or emotional distress at any stage of their illness. While hospice also offers palliative care, it is reserved for individuals with a limited life expectancy who may require advanced symptom management and comprehensive home care.

A Palliative Care Story

Bill, a 67-year-old retired Air Force pilot was vacationing with his wife, Ruth, when his life took a tailspin.

He began to experience difficulty swallowing and gnawing abdominal pain. Back at home, Bill’s doctors found cancer in his pancreas. Bill did not waver when cancer specialists at Penn's comprehensive cancer center, the Abramson Cancer Center recommended an aggressive treatment program of chemotherapy and radiation.

His oncologist prescribed pain medicines, but the pain broke through sapping his appetite and disrupting his sleep. His wife, Ruth, was concerned that at this rate Bill would not be able to tolerate his full treatment.

For extra help, Bill’s doctor referred him to Michael Ashburn, MD and Barbara Reville, DNP, CRNP clinic, at Penn’s Perelman Center for Advanced Medicine. In addition to his pain, the team asked Bill and Ruth about other symptoms and practical needs. As a result of a change in his pain medicine and a referral for home nursing visits, Bill is back on course toward recovery.

Bill and Ruth continue to hope for the best. During discussions with the palliative care professionals, they expressed a desire for complete and honest information from their doctors about Bill’s progress and his options. There may come a time when less treatment and more palliative care are best for Bill. If his symptoms worsen, palliative care professionals can partner with Bill’s oncologist to optimize his medicines and discuss options.

But for now, Bill maintains his recovery plan and is living well.

Learn more about palliative care at Penn Medicine.

Learn more about Penn Home Care & Hospice Services.

Kava Schafer, MDiv, MA, is a palliative care chaplain and member of the symptom management and palliative care program pain team at the Hospital of the University of Pennsylvania (HUP). As part of caregiver awareness month, Kava blogs about her role as a spiritual care provider to patients with cancer and their families.

I am the spiritual care provider for the nurse practitioner solid tumor oncology palliative care team at Hospital of the University of Pennsylvania (HUP). By writing this blog, I hope to give you an understanding of what it can mean to someone living with cancer to have a chaplain at the bedside when a team of clinicians makes its rounds.

Our multidisciplinary team of cancer specialists responds to the physical, emotional, and spiritual needs of the patient. Its primary intention is to address the symptoms of disease, alleviate suffering, and increase the quality of each person’s life while living with illness. My role, within this team, as a bedside spiritual provider is to help patients understand if and how emotional and spiritual experiences contribute to their pain. I am there to remind patients of their innate wholeness as human beings during crisis.

Earlier this year, Deborah had been under our inpatient care for more than three weeks.  Only 50 years old, she lived in rural Kentucky with her husband and two children. After living for more than four years with papillary thyroid cancer, she traveled to HUP to participate in a phase II clinical trial.

During Deborah’s stay, her care team focused on many goals; one of which was addressing the pain in her right shoulder.I rounded with the team on the day that the suggestion was made that she needed to postpone her return to KY.
Imaging studies could determine whether or not there was an infection in the shoulder needing antibiotics.

Deborah had been hoping for permission to leave. Throughout her hospitalization, in spite of excruciating pain and great uncertainty, she always expressed her emotions directly. On the morning she learned she would not be discharged right away, she broke down in tears. She didn’t know what to do – stay, or leave against the team’s wishes.

At the time, I didn’t know Deborah well, but when she mentioned through her tears she had a strong faith that grounded her, I waited until the team left the room and asked Deborah if a prayer would help her to make a decision. She immediately said yes, and we prayed for clarity. The tension in the room melted away.

I left her to her own thoughts and feelings, and five minutes later, she announced she would stay and follow the medical advice.

Ultimately, after her biopsy, Deborah found out her tumor had transformed into fast moving anaplastic thyroid cancer. We stabilized her and managed her pain so that she could return home to KY.Everyone who crossed her path as a caregiver was moved by her resiliency and strength. I remember Deborah telling us frequently she felt safe at Penn, even though she was far away from home.

Her family never left her completely alone and I was moved by such devotion and love crossing great distances.

As a chaplain on a team focused on symptom management throughout the continuum of care, my presence may serve to remind each patient what is essentially and spiritually important to them during treatment. Remembering what sustains and nourishes us during crisis is often a source of healing strength and consolation.


If you interested in palliative care services for yourself or a loved one, please speak with someone your cancer care team.