| In a youth-oriented culture, the topic of terminal illness and death is not a common discussion — even family members often have a difficult time talking to their loved ones about it. Yet families who face decisions about aggressive care options (procedures like feeding tubes and repeated surgeries to prolong life) may not know their loved ones’ true wishes if they didn’t talk about it before hand.
That was one of the observations made by an ethics committee of Franciscan Health System about a decade ago. The committee, which discussed ethical issues in health care, realized that most issues were related to end of life care, and there was an urgent need to find a way of learning about patients’ and families wishes in advance.
“America is very youth oriented — to get old and feeble and frail is not fun, not reverenced,” says Georganne Trandum, director of the Gig Harbor-based Improving Care Through the End of Life. “In Europe, (end of life) is just part of the circle of life — not a hush-hush thing.”
Trandum, RN, OCN, was an oncology bone marrow transplant nurse when, as the member of the ethics committee, she recognized the multifaceted need for continuous palliative care — and that there was no program anywhere in the country addressing those issues. A small Franciscan team, including Trandum and Dr. Mimi Pattison, participated in the Health Care Improvement Collaborative, Improving Care at the End of Life — and through that involvement, they launched a pilot program.
The concept started out with Trandum, Pattison, one volunteer and one patient — and quickly grew to 100 patients. Over the past decade, the program was expanded to a total of 10 clinics and has served thousands of patients. Currently, it has around 800 patients at any given time. A chaplain, a nurse and a volunteer are on the team that works with each patient, as well as the patient’s family.
“Our goal is to assess the patients and what they need right now, then educate them about their advanced directives and their hospice benefit,” Trandum says. She says many people don’t realize what kind of hospice benefits they are entitled to, and don’t take full advantage of them. The goal of the program is to create a bridge, a continuum of care between the patients’ medical facility and hospice.
The program is implemented in a primary-care clinic setting, with the intent of providing the best possible quality of life through symptom control, relief of suffering, emotional and spiritual support, as well as to educate physicians how to identify patients who qualify for the services. The approach Trandum and her group found most effective was to ask physicians, “If this patient dies within the next year, will you be surprised?” Once the patients are identified, the physician collaborates with a nurse, who coordinates the patient’s support services.
Improving Care Through the End of Life been recognized nationally. Trandum wrote a 13-chapter manual, and helped found similar programs in three other states. She travels around the country to speak about end of life care and share the success of the Franciscan initiative. In 2000, the program received the Circle of Life award from the American Hospital Association for innovation in end-of-life care. Three programs received the award that year, which was given for the first time. In 2006, Trandum also received the Nurse of the Year award in leadership from the March of Dimes of Washington.
Asked whether it’s difficult to work in an environment were death and dying is part of the daily conversation, Trandum said, “I think anyone who does this work is called to do it — you need to want to help someone during that part of their life… Life can be good until the last moment… We always have hope.”
For her part, Trandum seems to have found her calling. A former elementary school teacher, she got a nursing degree after taking a 10-year hiatus to raise her children, and when she was ready to return to work, realized there was little demand for teachers. She started out in pediatrics, helping develop the pediatric unit at St. Joseph Medical Center in Tacoma.
While working with cancer patients, she helped open the hospital’s bone marrow transplant center. Eventually, she switched to adult oncology, which led to her involved with the ethics committee, and culminated with her taking a leadership role to create the Improving Care program. First working hands-on as a nurse, she had to give that up as the organization expanded in order to focus on administration.
Trandum, who is a Key Peninsula resident, sees her nearly-30 year career as a continuum in itself, with all her previous steps leading to her success with Improving Care Through the End of Life. The members of her staff wrote in their nomination letter for the March of Dimes award: “From pediatrics to end-of-life care, Georganne Trandum has pioneered advocacy, innovation and leadership in promoting excellence in nursing and within her community.”
Even as the program celebrates many successes, the work to advocate for terminally ill patients remains ever-important. Palliative care is now an emerging, officially recognized field in medicine, but the education and the dialogue continues — including the education of physicians in order to promote caring conversations with patients.
“The biggest problem is still the physicians. They are trained to treat,” Trandum said. “When a patient chooses not to continue treatment, that’s hard on doctors.”
She is proud that the program she helped create “is making a positive difference in the lives of hundreds of patients who are facing life-limiting health issues and difficult choices.”
“For me, the greatest reward is ensuring that patients and their families receive information about, and are connected with, excellent end-of-life care, and eventual referral for hospice care.”. | 