On a Thursday afternoon last fall, 23 physicians, nurses and social workers at Yale-New Haven Hospital (YNHH) met to discuss a case that made everyone uncomfortable: a patient with colon cancer suffered serious and eventually fatal complications following surgery, and the patient’s daughter refused to leave her side or her room during the two-month hospital stay. The daughter would not allow staff to communicate directly with her mother and slept much of the day in the hospital room, denying access to nurses even when they attempted to administer medications or other care.
The discussion was part of the Schwartz Center Rounds, a program that creates a forum for caregivers to discuss complex emotional and social issues involved in caring for patients. In 1995, Kenneth B. Schwartz, a health care attorney in Boston, was dying of lung cancer. He was fortunate to receive not just top-notch medical care, but also an attention to his comfort and quality of life that made his illness easier to cope with for himself and his family. Shortly before his death, he established the Kenneth B. Schwartz Center, a nonprofit organization that has been helping caregivers provide compassionate care to their patients since 1997. The Schwartz Center Rounds now operate in approximately 100 hospitals in 25 states; the program was brought to the Yale Cancer Center last February as part of a larger effort to increase the focus on supportive care for patients with severe illness.
“It’s a unique forum for talking about difficult and challenging situations in a nonmedical fashion,” said Kenneth D. Miller, M.D., assistant professor of medicine (medical oncology), director of supportive care programs at the Center and the rounds leader for the program. Open to all YNHH staff, the rounds take place once a month and feature a presentation by a medical team followed by a group discussion.
Past topics of the Schwartz Center Rounds have included obtaining informed consent from mentally ill patients; keeping hope alive; and what to do when the patient, doctor and family are not on the same page. “We’re trying to develop a broader view on how different patients, and different families cope with really difficult situations that may be different than what we might have chosen for ourselves or what we think we’d choose,” Miller said.
According to Marjorie Stanzler, director of programs for the Schwartz Center, the ability of caregivers to voice their concerns in a safe environment translates into new insights into caring for patients, an appreciation of the problems faced by colleagues in other disciplines and the realization that they are not alone in dealing with troublesome circumstances.