The “support” in supportive and palliative care

For Bryan Struck, MD, director of the Supportive and Palliative Care Program at University of Iowa Health Care, the heart of palliative care isn’t about giving up. It’s about helping patients and families make informed decisions that reflect what matters most to them.

“Meeting people where they are” is how Struck describes the team’s approach. Whether a patient is newly diagnosed with a serious illness, pursuing aggressive treatment, or nearing the end of life, the goal is the same: understand the patient’s priorities, provide clear information, and support decisions that align with those values.

“Palliative care isn’t just for the end of life,” Struck said. “We can follow patients throughout the course of their illness from diagnosis through treatment.”

That philosophy has helped establish this institution as a leader in the field. More than a decade ago, UI Health Care became one of only about 10 hospitals in the nation to first earn The Joint Commission’s (JCO) advanced certification in palliative care. Today, about 1,500 hospitals report having a palliative care team, but it is estimated that only about 120 programs nationwide have earned the JCO designation. UI Health Care is the only medical center in the state to hold the certification.

The certification, earned jointly with the pediatric palliative care program, requires the team to demonstrate excellence across several quality measures, including comprehensive pain assessments, evaluation and treatment of shortness of breath, documentation of goals-of-care discussions, and ensuring those conversations are reflected in discharge planning.

Each of those metrics contains an element of what Struck believes is the most important part of palliative care: communication. Patients receiving care for serious illnesses often interact with numerous specialists, each focused on a different aspect of treatment. The palliative care team helps bring those perspectives together.

“We’ll ask patients, ‘What have the teams been telling you?'” Struck said. “Then we help synthesize all the information so patients and families can make an informed decision.” He emphasizes the team’s focus as well on guiding patients and their families toward their specific goals after helping them evaluate all options.

The discussions are especially valuable for patients with complex medical conditions, where treatment decisions can be difficult and there may not be a single “right” answer. Sometimes the team’s role is helping patients pursue additional treatment. Other times, it’s reassuring them that it’s acceptable to decline interventions that no longer fit their goals.

“Our job is to understand what matters most to the patient,” Struck said. “Then we work with the rest of the medical team to determine whether we can deliver on those goals.”

That patient-centered approach depends on an interdisciplinary team that addresses not only physical symptoms but also emotional, social, and spiritual needs.

The program currently includes four full-time physicians, with a fifth physician expected to join the team. Three additional physicians contribute part time from obstetrics, emergency medicine, and psychiatry. The clinical staff also includes four full-time nurse practitioners, three full-time social workers, three chaplains (dedicated 1.5 FTE), and a music therapist.

Even with that broad range of experts, Struck sees opportunities for growth. He would like to add a clinical pharmacist to assist with medication

management, particularly for patients with complex symptoms. Currently, the ACGME-accredited Hospice and Palliative Medicine Fellowship trains two fellows per year, and they hope to expand soon to a third slot. Applicants are welcome from nearly a dozen different medical specialties.

As the field evolves, so do the patients who benefit from palliative care. The team is increasingly involved with patients living with advanced heart failure, neurological diseases, and those undergoing left ventricular assist device (LVAD) implantation. In these cases, palliative care often begins well before surgery, helping patients and families understand what recovery may look like and whether treatment aligns with their expectations and long-term goals.

Technology is expanding the program’s reach as well. Telehealth visits allow family members from across the country to participate in conversations about care. On a single video call, relatives joining from multiple locations often fill the screen—what Struck joked resembled the opening credits of “The Brady Bunch.”

For families facing some of life’s most difficult decisions, those conversations can provide clarity, comfort, and confidence that the path forward reflects the patient’s own priorities.

Ultimately, Struck says, palliative care isn’t about steering patients toward a particular choice. It’s about making sure they have the information, support, and space to decide for themselves.

“We’re there to help people understand all the information,” he said, “and then ask the question: What matters most to you?”