Palliative Care Service is an interdisciplinary service for patients with advanced incurable illnesses, and their families, dedicated to relief of suffering and improvement of quality of life using a comprehensive approach. As the disease advances and it is evident that the patient is unlikely to survive, comfort measures become a priority. The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care expands the traditional disease-model of medical treatments to include the goals of enhancing quality of life for patients and addressing the spiritual and social needs of patients and their families.
Within the New York City Health and Hospitals Corporation, Lincoln is among the top providers of Palliative Care Services. Lincoln Medical Center takes care of 160,000 emergency visits, 400,000 outpatient visits, and 30,000 inpatient discharges annually. Our consultative palliative care service has been active since 2004 and has grown to provide palliative services to more than 1,300 inpatients per year. Our training provides a wealth of clinical experience in the inpatient, outpatient, long term care, inpatient and outpatient hospice setting.
The Hospice and Palliative Care Fellowship Program at Lincoln Medical Center is fully accredited by the American Council of Graduate Medical Education – ACGME and provides comprehensive post-graduate training in all areas of the Hospice and Palliative Care. Lincoln Medical Center is located in the South Bronx (an area experiencing remarkable development and reinvigoration) and has long tradition of providing care to the underserved and the disadvantaged in the city of New York. The Palliative care services Lincoln have been awarded certification as an Advanced Palliative Care Program by The Joint Commission (initially in 2012, with ongoing certification, last re-certified in 2021).
The fellowship program seeks to ensure that the fellows develop skills, knowledge and attitude necessary for a career in Hospice and Palliative Medicine. On graduation, the house officer is expected to possess detailed knowledge and practical skills to pursue successful careers as hospice and palliative care specialists.
- Provide a multi-disciplinary assessment of patients with debilitating illnesses and a holistic approach to interventions.
- Effectively relief symptoms such as pain in the course of advanced illness.
- Guide patients and their families in defining goals of care based on their preferences, culture and spirituality.
The one year fellowship comprises of the following rotations:
- Inpatient Consultative Service Experience
The fellows’ inpatient experience will comprise a minimum of four months, typically 6 months, and will include a diverse patient population with significant social, supportive and symptom control needs. The acute care inpatient consultative service consults on patients with a very broad array of diagnosis pertaining to Cardiology, Pulmonology, Infectious Disease, Oncology, Hematology, Neurology, Nephrology, Geriatrics, Surgery, Trauma, Rheumatology and Gastroenterology. The consults arise from all across the institution medical / surgical floors, medical surgical intensive care units, emergency rooms etc. The service is consulted on patients with advanced and life-threatening illnesses to manage symptoms such as pain, dyspnea, nausea and vomiting, delirium, terminal agitation and restlessness, as well as complex discharge planning, defining goals of care, resolving ethical dilemmas and spiritual / social concerns.
Apart from symptom management the team facilitates complex family meetings to establish goals of care, healthcare proxy, advance directives and non-resuscitation orders. The fellows will gain abundant experience in issues surrounding the withdrawal of life sustaining treatments for which we have developed an institutional protocol and management of symptoms at the end of life.
The fellows will interact with the IDT and playing an instrumental role in assessing and coordinating the implementation of recommendations. Interventional pain experts are available to complement fellows learning on these strategies. The fellows will learn and provide bereavement therapy with the interdisciplinary team and facilitate debriefing on the acute care floor where a death occurs. The fellows will also learn about the acute treatment of palliative emergencies such as spinal cord compression, brain metastases, superior vena cava syndrome and hypercalcemia. Rotation through Pediatrics service will provide the fellows with an opportunity to learn the palliative aspects of pediatric care. The fellows will attend Ethics Committee meetings and share consultations with the Ethics Committee members (many overlap with Palliative Care patients). Best practices have been compiled in the form of booklets, policies and literature syllabus to facilitate learning and online educational resources are readily available at the bedside. The fellows will hold Journal clubs and participate in ongoing committees such as ethics, tumor board, organ donation and palliative performance improvement.
- Ambulatory Care Experience
Lincoln has an established Palliative Care ambulatory clinic. This clinic expands access to palliative care services to patients that suffer from advanced debilitating illnesses that live in the community. Referral sources include patients known from inpatient consultation or new cases referred from other primary or specialty clinics. The diagnoses of the clinic patients include: advanced heart failure, cancer, neurodegenerative diseases, advanced lung disease, and end-stage renal / liver failure. The fellows ambulatory care experience is longitudinal throughout the year to facilitate continuity and evaluation of outcomes as the fellows will care for the patients throughout the trajectory of their illness from inpatient to clinic follow up and eventually hospice. The fellows are supervised by an attending physician in a one-on-one mentoring structure and with support of the interdisciplinary clinic team. The fellow will master the treatment of symptoms that are prevalent in the outpatients with life-threatening medical conditions. The fellows will learn about Opioid pharmacotherapy initiation, titration and rotation to best treat symptoms of pain and dyspnea. Other commonly managed symptoms include fatigue, anxiety, nausea, vomiting, depression and constipation. In addition to medical management, patient and family education is paramount in the ambulatory care setting. Addressing Goals of care, advance directives, health care proxy, delivering of bad news and referring patients to comprehensive home care services. The fellows also learn to identify patients that need to be admitted to inpatient service for intensive pain and symptom management or those who need to be transitioned to home or inpatient hospice. Full interdisciplinary support is available on site during the ambulatory visit.
- Long Term Care Experience
The long-term care experience will comprise a minimum period of one month (4 weeks) for each trainee and will take place at the Elizabeth Seton Pediatric Center. The fellow will conduct morning rounds with an attending physician, Dr. Alvin Moyer, participate in interdisciplinary rounds, and patient and family meetings to establish improved symptom control, address goals of care, establish health care surrogacy and advanced directives. All aspects of this rotation are mentored by the attending physician and the interdisciplinary team. During this experience the Fellows will be an integral member of the IDT, will present and discuss the patients with the team and faculty and will follow up the patients assigned to them. The fellows will participate in educational activities as well.
- Hospice Experience
The fellows Home Hospice experience will take place through the VNS hospice program. The hospice experience consists of two and one half months rotation. A minimum of 25 home visits are expected to occur. The fellows will also rotate through VNS’s inpatient hospice units. The fellows will evaluate the patients under supervision of the attending physician and with other interdisciplinary team members, including registered nurses who are certified in hospice and palliative medicine, medical social workers and chaplains. The fellow will evaluate and discuss the cases with the IDT members and tailor the care plan based on this care setting. The team will execute the plan in parallel with the patient and the family goals of care. The fellow will complete a log of the home hospice cases which will be discussed as clinical vignettes based on the interventions and outcomes. The fellows will provide patient and family education on end of life; provide symptom control, psychosocial and spiritual support. The fellows collaborate with the hospices’ bereavement program. If interested fellows will be provided the opportunity to rotate at Harlem Hospital in collaboration with VNS to learn about Hospice administration and becoming a Hospice Medical Director in the future.
Fellows have an elective rotation opportunity in an area of special interest. Elective rotations are available in Ethics, Oncology, Radiation Oncology, Emergency Medicine, Behavioral Health, HIV, Neurology, Geriatrics, Pain/Interventional Pain Medicine, Pediatrics NICU, Pediatrics Developmental Behavioral Medicine, Physical Medicine and Rehabilitation (PM&R), Critical Care, Cardiology, Research and Pulmonary. The fellows will have a dedicated research component as Lincoln has an independent IRB (Institutional Review Board). Data and statistical analysis support is provided by our institution.
4 weeks that can be taken consecutively or split as per the fellow and PD discretion.
The principal teaching methods in Hospice and palliative care fellowship program involve a combination of individual patient-based encounters, case discussions and a series of didactic conferences. In each individual patient encounter, there is a detailed discussion with an attending physician. The didactic conferences similarly utilize a patient-based approach to integrate the basic sciences of pathophysiology with clinical presentations and an evidence-based approach to diagnosis and management. It is our strong belief that this patient-based approach utilizing both individual and group teaching maximizes our educational efficacy.
Medical Grand Rounds
Prominent guest speakers, covering a wide range of important topics in Internal Medicine and its subspecialties – Fridays at 8AM – Auditorium
Didactic sessions – Lectures, M&Ms, Journal Clubs –
Thursdays at 10AM – GME conference room 5C 192
Morbidity and Mortality Conferences
This conference is held monthly within the Department of Medicine to discuss deaths and problematic cases, identified by the ACMR, attending staff, or through the CQI process. The cases are presented by the PGYII or PGYIII who was not involved in the care of the particular patient in order to ensure an in depth and objective discussions of the issues identified. The conference is attended by the medical house staff, medical attending staff, the Program Director and Chief of Service. The ACMR is responsible for moderation of the case discussion.
In collaboration with Oncology, Radiation Oncology, Surgical Oncology and Subspecialists – Wednesdays at 8AM – Radiology 2C3 Room 578
With Psychologist Dr. Sandra Runes on the first and third Thursdays of each month at 1PM – 4A Conference Room
Organ Donation Committee Meetings (ECHO)
Held on the last Friday of every rotation in collaboration with Critical Care Physicians and LiveON NY – at 12PM in Conference Room 4
Daily at 830AM – 9A in the Chemotherapy Suite
Palliative Care Interdisciplinary Team Rounds and Bereavement Rounds
Tuesdays at 10AM – GME conference room 5C 192
*Team consist of Attending Physicians, Fellows, Nurse Practitioner, Registered Nurse, MST, Social Workers, Chaplains, rotating Residents and Students
Research and Quality Improvement Meetings
Held quarterly, time/date TBD
Palliative Care Committee Meetings
Held quarterly, time/date TBD
- Nilsa Velazquez, Hospice and Palliative Medicine Program Coordinator
- Melissa Headley, MD, Palliative Care Attending
- Simona Dlabal, NP, Palliative Care Nurse Practitioner
- Sasha-Gaye Sharrier, RN, Palliative Care Nurse
- Ileana Dejesus, MST, Palliative Care Associate
- Giulia Herman, LCSW, Palliative Care Social Worker
- Father Bartholomew Amobi, Palliative Care Chaplain
Dr. Ehsen Rao, MD
Dr. Ritchell Dignam, MD – VNSNY Director
Dr. Alvin Moyer – Elizabeth Seton Pediatrics Center Director
If you have any questions, please don not hesitate to reach out to our Program Coordinator: Ms. Nilsa Velazquez firstname.lastname@example.org 718-579-6679