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When Children Need Palliative Care with Kelly Michelson, MD, MPH

Anticipating, preventing and treating suffering is at the heart of excellent palliative care. Kelly Michelson, MD, MPH, discusses the importance of palliative care in pediatric hospitals and how she works with young patients and their families when they're facing a deadly health condition.



Kelly Michelson, MD, MPH

"The real focus is on minimizing suffering. And not just suffering for the patient, but for the whole family. What that might look like is really going to be very different for every family."

Kelly Michelson, MD, MPH

  • Director, Institute for Public Health and Medicine, Center for Bioethics and Medical Humanities
  • Julia and David Uihlein Professor of Bioethics and Medical Humanities
  • Associate Professor of Pediatrics in the Division of Critical Care
  • Attending Physician, Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago

Episode Summary

A popular definition for palliative care, used by many medical professionals as well as the Centers for Medicare and Medicaid Services, is: patient and family-centered care that optimizes quality of life by anticipating, preventing and treating suffering.

Kelly Michelson: "Nowhere in that definition do I or do people who agree with that approach talk about dying or death or even end of life. The real focus is on minimizing suffering. And not just suffering for the patient, but for the whole family. What that might look like is really going to be very different for every family...dying for one child and one family may look very different than for another family."

Much of Michelson's work at the the Ann and Robert H. Lurie Children's Hospital of Chicago involves meeting with families and patients and listening to their concerns and finding ways to minimize suffering for the whole family.

Kelly Michelson: "I think that's one of the challenges and the opportunities for palliative care and for people who work in this area is to find what the family needs, to adapt to whatever is going on in their world, to their needs and their interests."

According to the National Institute on Aging, through palliative care, doctors can work as long as possible to provide treatment to seriously ill patients in hopes of finding a cure. This is an important aspect that separates palliative care from hospice care, Michelson says. Hospice refers to the care of anyone with an expected mortality of six months. A lot of insurance companies will pay for hospice, but not if you're getting therapies that would be considered curative. And to complicate the matter, she says in some states, such as Illinois, you cannot qualify for palliative care unless you are eligible for hospice care. 

Kelly Michelson: "That's problematic for a number of reasons. The first of which is that we oftentimes cannot predict when a person is going to die in the adult world. It's hard. In the pediatric world, it's often a 10 times harder, because kids are resilient in ways that we can never predict."

Aside from the curative treatments, patients receiving palliative care at Lurie Children's have access to art therapists, child life specialists, music therapists, social workers, case managers and chaplains, Michelson says. Art and music therapy are used to manage symptoms and ease suffering in young patients. Because palliative care is often so difficult to fund through insurance companies, she says almost all of these services are funded through philanthropy. 

Kelly Michelson: "I think art therapy and music therapy can really get at the suffering challenges. Music therapy in particular is an amazing avenue for managing symptoms, whether it's pain or nausea or fatigue. I think it is an area that's really ripe for investigation: exactly how do these therapies integrate in palliative care and how effective are they and why are they effective and what parts of them can we focus on to make them even more effective?" 

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Continuing Medical Education Credit

Physicians who listen to this podcast may claim continuing medical education credit after listening to an episode of this program.

Target Audience

Academic/Research, Multiple specialties

Learning Objectives

At the conclusion of this activity, participants will be able to:

  1. Identify the research interests and initiatives of Feinberg faculty.
  2. Discuss new updates in clinical and translational research.
Accreditation Statement

The Northwestern University Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

The Northwestern University Feinberg School of Medicine designates this Enduring Material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Statement

Kelly Michelson, MD, MPH, has nothing to disclose. Course director, Robert Rosa, MD, has nothing disclosure. Planning committee member, Erin Spain, has nothing to disclose. Feinberg School of Medicine's CME Leadership and Staff have nothing to disclose: Clara J. Schroedl, MD, Medical Director of CME, Sheryl Corey, Manager of CME, Jennifer Banys, Senior Program Administrator, Allison McCollum, Senior Program Coordinator, and Rhea Alexis Banks, Administrative Assistant 2.

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