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Supportive & Palliative Care

Supportive & Palliative Care is focused on improving the quality of life for you and your family by reducing the physical and emotional burden of illness, through expert use of symptom management, supportive counseling and advanced care planning. Clinical guidelines recommend that all patients with serious illness be offered supportive and palliative services early in the course of the disease and throughout all stages of treatment. Through supportive and palliative care, you may experience milder symptoms, require less time in the hospital and report feeling better. Palliative Care clinicians work closely with Hospitalists to provide comprehensive care designed especially for your needs.

How can Supportive & Palliative Care help you and your family?

  • Symptom management: expertise in treating pain, fatigue, constipation, breathing difficulties, nausea, loss of appetite, anxiety and depression. Ultimate goal is to prevent and ease suffering and improve your quality of life.
  • Advanced care planning:  guidance with difficult treatment decisions, help with navigating the health care system, assistance with Advanced Directives.
  • Strong physical, emotional and spiritual support throughout all stages of illness
  • Supportive counseling: clear and compassionate communication with doctors and family members. Nurse navigators, chaplains and social workers assistance­ with coordination of care with community services.

Palliative care is a central part of treatment for serious or life-threatening illnesses. The information in this website will help you understand how you or someone close to you can benefit from this type of care.

Ask your health care provider about a referral for Supportive & Palliative Care services, or call us at ph# (603) 740-3330



The Supportive & Palliative Care Team

Agata Marszalek, MD

Agata Marszalek, MD, Director of Supportive & Palliative Care joined the Wentworth Health Partners team from the North Shore-LIJ Health System in New Hyde Park, NY where she completed a Geriatric and Palliative Medicine fellowship.  She is board certified in Internal Medicine, Geriatric Medicine, and Hospice and Palliative Medicine.  Dr. Marszalek specializes in pain management and facilitating conversations about life-prolonging treatments.  Her gentle bedside manner reflects her compassion for people who are living with serious illness. 

Amy Dumont, APRN

Amy Dumont, APRN has been working within the Wentworth-Douglass Health System since 1997, and joined the Supportive & Palliative Care team in November 2014. Amy is a graduate of Simmons College's Doctor of Nursing Practice Program and the Master of Science in Nursing - Family Nurse Practitioner program. She is Board Certified through the American Nurses Credentialing Center as a Family Nurse Practitioner, and was inducted as a member of Sigma Theta Tau in 2012. Amy has a strong background in patient-centered care and her warm-hearted nature is comforting to patients and their families.

Michele Loos, APRN

Michele Loos, APRN joined the Supportive & Palliative Care team in August 2014 after completing the Family Nurse Practitioner Post-Master's Certificate Program at the University of New Hampshire, where she also earned her Bachelor of Science in Business Administration and Master of Science in Nursing. Michele is also Board Certified in Hospice and Palliative Nursing, and her gentle approach in providing palliative care is embraced by patients and their families.

Barbara Stuart, RN, CHPN

Barbara Stuart, RN, CHPN has been the Clinical Coordinator for Supportive & Paqlliative Care since July 2009. She is Board Certified in Hospice and Palliative Nursing and has extensive experience in caring for people who are living with serious illness. Barbara's caring nature and ability to connect with patients and families is invaluable in the delivery of compassionate care.

Pat Coughlin, MSW

Pat Coughlin, MSW joined the Supportive & Palliative Care team in October 2014.  She received her Masters' in Social Work from the University of Utah, and after working in the mental health field for 15 years, became a hospice social worker in 1999.  Pat's warmth, compassion, and knowledge of community resources are valuable components in the support of patients and families who are coping with serious illness.

Shelly Snow, MEd, MDiv, Chaplain

Shelly Snow, MEd, MDiv, Chaplain joined the Supportive & Palliative Care team in October 2014, and is eligible for Board Certification in Palliative Care. She earned her Masters of Divinity at Bangor Theological Seminary, and completed her residency at Maine Medical Center's Oncology Service Line. Shelly is an Ordained UCC minister and has served as pastor, teacher, and chaplain, and is devoted to comforting patients and families in their greatest time of need.




























What is palliative care?

  • Palliative care is comprehensive treatment of the discomfort, symptoms and stress of serious illness. It does not replace your primary treatment; palliative care works together with the primary treatment you’re receiving. The goal is to prevent and ease suffering and improve your quality of life.

If you need palliative care, does that mean you’re dying?

  • The purpose of palliative care is to address distressing symptoms such as pain, breathing difficulties or nausea, among others. Receiving palliative care does not necessarily mean you’re dying.
  • Palliative care gives you a chance to live your life more comfortably. Palliative care provides relief from distressing symptoms including pain, shortness of breath, fatigue, constipation, nausea, loss of appetite, problems with sleep and many other symptoms. It can also help you deal with the side effects of the medical treatments you’re receiving. Perhaps, most important, palliative care can help improve your quality of life.

Is Supportive & Palliative care different from hospice care?

  • Supportive & Palliative care is available to you at any time during your illness. Remember that you can receive palliative care at the same time you receive treatments that are meant to cure your illness. Its availability does not depend upon whether or not your condition can be cured. The goal is to make you as comfortable as possible and improve your quality of life.
  • You don’t have to be in hospice or at the end of life to receive palliative care. People in hospice always receive palliative care, but hospice focuses on a person’s final months of life. To qualify for some hospice programs, patients must no longer be receiving treatments to cure their illness. Palliative care also provides support for you and your family and can improve communication between you and your health care providers.


Palliative care strives to provide you with:

  • Expert treatment of pain and other symptoms so you can get the best relief possible.
  • Open discussion about treatment choices, including treatment for your disease and management of your symptoms.
  • Coordination of your care with all of your health care providers.
  • Emotional support for you and your family.

Palliative care can be very effective

Researchers have studied the positive effects palliative care has on patients. Recent studies show that patients who receive palliative care report improvement in:

  • Pain and other distressing symptoms, such as nausea or shortness of breath.
  • Communication with their doctors and family members.
  • Emotional support.
  • Other studies also show that palliative care:
    • Ensures that care is more in line with patients’ wishes.
    • Meets the emotional and spiritual needs
    • Supportive & Palliative Care is comprehensive care designed specifically for your needs

Palliative care can improve your quality of life in a variety of ways.

Together with your primary health care provider, your palliative care team combines vigorous pain and symptom control into every part of your treatment. Team members spend as much time with you and your family as it takes to help you fully understand your condition, care options and other needs. They also make sure you experience a smooth transition between the hospital and other services, such as home care or nursing facilities. This results in well-planned, complete treatment for all of your symptoms throughout your illness – treatment that takes care of you in your present condition and anticipates your future needs.

A team approach to patient-centered care

Palliative care is provided by a team of specialists that may include:

  • Palliative care doctors
  • Palliative care nurse practitioners
  • Palliative care nurse coordinators
  • Social workers
  • Chaplains
  • Nutritionists
  • Counselors and others

Special care that supports you and your wishes

Palliative care supports you and those who love you by maximizing your comfort. It also helps you set goals for the future that lead to a meaningful, enjoyable life while you get treatment for your illness.

How do you know if you need palliative care?

Many adults and children living with illnesses such as cancer, heart disease, lung disease, kidney failure, dementia, among others, experience physical symptoms and emotional distress related to their diseases. Sometimes these symptoms are related to the medical treatments they are receiving.

You may want to consider palliative care if you or your loved one:

  • Suffers from pain or other symptoms due to ANY serious illness.
  • Experiences physical or emotional pain that is NOT under control.
  • Needs help understanding your situation and coordinating your care.

Start palliative care as soon as you need it

It’s never too early to start palliative care. In fact, palliative care occurs at the same time as all other treatments for your illness and does not depend upon the course of your disease. There is no reason to wait. Serious illnesses and their treatments can cause exhaustion, anxiety and depression. Palliative care team understands that pain and other symptoms affect your quality of life and can leave you lacking the energy or motivation to pursue the things you enjoy. They also know that the stress of what you’re going through can have a big impact on your family. And they can assist you and your loved ones as you cope with the difficult experience

We work with you and your primary care physician

Patients who are considering palliative care often wonder how it will affect their relationships with their primary doctors. Will I have to give up my primary doctor?
Will I offend my doctor if I ask questions? Most important, you do NOT give up your own doctor in order to get palliative care. The palliative care team works with your doctor. Most doctors appreciate the extra time and information the palliative care team provides to their patients. Let your doctor know if you think palliative care could help you. You may also wish to contact your palliative care team. They can help you explain why you would like to receive palliative care.

How do you get palliative care?

The process begins when your doctor refers you to the supportive and palliative care team. You can also ask your doctor for a referral. Our supportive and palliative care team can see you while in the hospital, at the Seacoast Cancer Center or in our Clinic located in the hospital by south entrance.

Does insurance pay for palliative care?

Most insurance plans cover all or part of the palliative care treatment you receive, just as they would other services. Medicare and Medicaid also typically cover palliative care. If you have concerns about the cost of palliative care treatment, a social worker from the supportive and palliative care team can help you.

What happens when you leave the hospital?

When you leave the hospital, your supportive & palliative care team will help you make a successful move to your home or other health care setting. We can follow up with you and your loved ones at our outpatient Clinic located at the hospital or in the Seacoast Cancer Center.

If morphine is prescribed, will it be dangerous?

If you have an illness causing you pain that is not relieved by drugs such as acetaminophen or ibuprofen, the palliative care team may recommend trying stronger medicines such as morphine. Simply stated, morphine is an opiate – a strong medicine for treating pain. Like other similar opiate medicines (hydrocodone, oxycodone), it provides safe and effective pain treatment. In fact, almost all pain can be relieved with morphine and similar strong drugs that are available today. So no one should suffer because they or their doctor have concerns about morphine or other drugs in the opiate family.

If I take morphine, will I become addicted?

In fact, very few people who use opiates for pain relief ever become addicted or dependent on these medicines. However, it is important to be aware that anyone taking opiates for more than two weeks should not stop doing so abruptly. You should ask your doctor about gradually reducing your dose so that your body is able to adjust. There is no reason to wait until your pain is unbearable before you begin taking morphine. As your pain increases, your morphine dose can be safely increased to provide the relief you need over time. All opiates can cause nausea, drowsiness and constipation. However, as your body adjusts to the medicine, side effects will generally decrease. Also, side effects such as constipation can easily be managed.

As always, if you have concerns about taking these or any medications, talk to your palliative care team. They can tell you about how various medications work, what their side effects are and how to get the most effective pain relief.

For more information, contact Supportive & Palliative Care today at 603-740-3330


 http://www.mylungcancersupport.org/interactive-library/palliative-care-the-extra-layer-of-support.html Early Palliative Care: Improving Quality of Life Atul Gawande's "Being Mortal" 60 Minutes PBS Special



Palliative Care - the treatment that respects pain
The Buffalo News - taken from The New York Times, December 7, 2013

Anyone faced with a life-threatening or chronic illness should be so lucky as Catherine, a 27-year-old waitress in New York.  Dr. Diane E. Meier, a palliative care specialist at Mount Sinai Medical Center, recalled her young patient’s story in an article published in 2011 in the Journal of Clinical Oncology.

Letting Go
The New Yorker, August 2, 2010. 
Modern medicine is good at staving off death with aggressive interventions—and bad at knowing when to focus, instead, on improving the days that terminal patients have left.
A Better Kind of Care
Boston.com July 24, 2011
At Mass. General, and a growing list of hospitals nationwide, teams trained in palliative medicine are changing the way patients and their families live with serious illness – and cope with its toughest decisions


Advance Care Planning POLST in New Hampshire


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Phone: (603) 742-5252
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