Massachusetts General Hospital (MGH)
One of the oldest programs in the country, the Massachusetts General Hospital Division of Palliative Care has been providing inpatient consultation since 1996. More than 50% of the patients have a cancer diagnosis, and a substantial minority has primary cardiac, renal, pulmonary, or neurological problems. Fellows therefore learn to care for a diverse group of patients and become expert in understanding and forecasting disease trajectories for a wide range of illnesses. This diversity is further enhanced through the inpatient hospice program, where fellows care for symptomatic hospice patients admitted directly to MGH.
Brigham and Women's Hospital and Dana-Farber Cancer Institute (BWH/DFCI)
The adult Palliative Care Service at BWH/DFCI has been providing consultation services since 2001. Physician fellows spend approximately three months caring for patients on the Inpatient Consult Service and another three weeks caring for patients on the Inpatient BWH Palliative Care Unit. Nurse practitioner fellows spend approximately 6 months on the BWH Palliative Care Service, 2 weeklong rotations on the Inpatient Palliative Care Unit and elective clinical rotations. Both of these clinical programs emphasize interdisciplinary care and have daily interdisciplinary team meetings, including case-based teaching and bereavement rounds.
Boston Children's Hospital and Dana-Farber Cancer Institute (BCH/DFCI)
Fellows work with the interdisciplinary Pediatric Palliative Care Team/Pediatric Advanced Care Team (PACT) at Boston Children's Hospital and Dana-Farber Cancer Institute to gain exposure to the care of pediatric patients with life-threatening illness. PACT is one of the oldest pediatric palliative care programs in North America. Teaching focuses on advanced pediatric pain and symptom management, decision making, and quality-of-life concerns in both the inpatient and outpatient settings. Fellows will become familiar with comprehensive, interdisciplinary evaluation and management of children with diverse advanced illnesses and their families.
Care Dimensions Hospice (CD) and the Brockton VA Medical Center (BVA)
Fellows gain experience caring for patients in the home during their rotations with Care Dimensions, Seven Hills Pediatric Center, and the Brockton VA Medical Center. During this time, fellows participate in interdisciplinary team meetings and home visits. While physician fellows begin to learn the skills required to be a hospice medical director, nurse practitioner fellows collaborate with other team members to direct complex end-of-life care. All fellows who spend time with Care Dimensions also care for patients at the Kaplan House, a freestanding inpatient hospice facility.