An interview with Cheryl Williams, MD, PhD

Palliative Care

By Miriam Steinberg

Dr. Cheryl Williams is a palliative care physician associated with the University of Rochester Medical Center in Canandaigua. I recently had an opportunity to interview her on Zoom about her specialty; what  palliative care is and what a person can expect when referred to a palliative care physician.  Dr. Williams’ expertise and area of special interest is in pharmacology and how medications interact with each other and with the medical conditions that arise throughout life. She is also the Hospice Medical Director for Ontario and Yates Counties.

She provides palliative care for all cancers, as well as end-of-life and hospice care for all cancers.

Palliative care and hospice are words I’ve heard used interchangeably. There’s a fair amount of misunderstanding. Can you give an overview of what palliative care is?

Dr. Williams: We are a medical specialty. Palliative care is a term that can be applied to many different aspects in health care. There are visiting nurse services that offer palliative care services, so I want to make the distinction that we as physicians go through extra training and fellowships. It is now a formal fellowship. Much like a cardiologist or a renal doctor would go through extra training and a fellowship to focus on that particular aspect of care, we also go through that extra training. Our focus is on symptom management from a disease perspective, as well as addressing side effects of medications or other treatments that are used to treat the disease. We are also trained to deal with discussions on how to help people navigate as they’re going through the medical system.

I always tell people in their initial visits about the distinction between palliative care and hospice. I explain that because another physician referred you to see me, it’s not end of life care or hospice. I see mostly people who are going through treatments and surveillance for years to come. Lots of people ‘graduate’ from seeing me, as they have success from their treatments.

So palliative care can be used at any point in the process?

Dr. Williams: Correct. We often give the analogy that your disease starts at a point, and if and until you get to the serious part where you’re close to end of life, that’s when you cross into where you need hospice care. Because the symptoms tend go up as the disease progresses, it’s more likely that you’ll see someone for Palliative Care on that trajectory before or if you get to the end stage.

Could palliative care carry over into hospice?

Dr. Williams: Again, you get into a lot of semantics. The big difference between palliative care and hospice is that hospice has some restrictions on what the goal of care is. You need to be beyond the point of doing disease-directed treatment. Also, we have to estimate that the patient has six months or less left (although that amount of time is not a hard and fast number). Those are things that tend to differentiate between hospice and palliative care. Because we focus both on the whole person and symptom management to make sure someone is comfortable, there are overlaps. Many times, we will take care of people as they are going through their treatments and then continue that kind of symptom management as they’ve moved on to hospice care. So we can work hand in hand with hospice care.

Does a person receiving palliative care have to be an in-hospital patient?

Dr. Williams: We have the capability of consulting with patients in the hospital and also in outpatient clinics. We can start to see them in the hospital when they’re in a crisis or at the time of diagnosis of a disease so we can start symptom management there and carry over to outpatient land when they get back home.

Who qualifies for palliative care?

Dr. Williams: Anyone who has a serious illness that has symptoms that need to be managed. We sometimes get confused for pain management services and that is not what we do. In pain management, they have a similar approach. They often have interdisciplinary team members geared toward people who are in chronic pain. While we do have a lot of experience dealing with pain management, when somebody is struggling with something that is not a serious illness like chronic low back pain, those patients are better served by someone in a pain specialist clinic as opposed to palliative care.

How is palliative care beneficial to those who are going through treatment for breast or gynecologic cancer?

Dr. Williams: We work very closely with the oncologists because treatments can change mid-stream and with that comes different symptoms that need to be managed. Many times we can provide a supportive place where people can go and have their symptoms addressed. We work closely with their oncologist in particular. We also work with social workers and there are some complementary treatments we can incorporate as well. We realize that suffering can take many forms, which is why we work with social workers and chaplains to give people comfort on that level. So we try to address how we can make people feel whole. Some of these services are also available to family members who need it as well.

How does a person get in touch with a palliative care provider and how does someone know that they need it?

Dr. Williams: Every major hospital system in the Rochester area has palliative care services. Usually what happens is that the person’s providers can make the referral to have that person consult with someone from the palliative care team. Some places will allow a family member to request a consult.

How did you become involved with palliative care?

Dr. Williams: It was a convoluted path in this career. I started out as a pharmacist and I got my Ph.D. in pharmaceutical sciences. I went to medical school and after I finished, I started out as a hospitalist. When I was working at a hospital in that capacity, one of the hospice nurses said that I had a unique way of making people feel at ease and helping them through difficult times and then asked me if I had ever considered doing hospice care. I hadn’t, but they pursued me. I then started out as a hospice medical director in the Saratoga Springs area and then moved to Canandaigua and continued mainly in the hospice realm. This was right as palliative care was starting. I worked with one of the very first people to go through the fellowship, who also happened to be starting a palliative care program at a local hospital. We worked together to get that off the ground, and that morphed into me helping to train most of the fellows, and that eventually transitioned into me being a palliative care physician.

I feel this specialty chose me. My background in pharmacy and pharmacology fits well into symptom management and, as a former hospitalist, I understand that medical care and the health care system can be complex to navigate. It is my goal to assist patients and their families – and to understand each patient as a person – before trying to make any recommendations about care. I also find satisfaction in providing compassionate care when helping people through difficult discussions.