Emergency medicine was practically the family business when Dmitry Kozhevnikov was a young EMT and his mother was an emergency room nurse. He assumed he’d become an ER doctor.

But during his medical training, Dr. Kozhevnikov knew he wanted more.

“I realized I wanted more continuity with patients—developing long-term relationships, spending time getting to know them, and delivering care that was more humanistic and person-centered,” he said.

Dr.Kozhevnikov is a Yale Medicine hospice and palliative medicine doctor and the director of outpatient palliative care, Smilow Hospital Care Centers. Following are portions of a recent conversation between Dr. Kozhevnikov and Eric P. Winer, MD, director of the Yale Cancer Center. You can listen to the entire conversation, which aired on the Sunday evening radio show Yale Cancer Answers on Connecticut Public Radio, here.

What is the difference between palliative care and hospice care?

Palliative medicine is subspecialized medical care for patients with a serious illness. It’s provided by teams—physicians, nurses, social workers, chaplains, psychologists, pharmacists—who come together to figure out where extra support can be added. It can be provided to patients at any age and stage of a serious illness, from diagnosis onward.

Hospice is a type of palliative care specifically for patients who are thought to be in the last six months of their lives. It’s not just the last week, and patients who enroll earlier actually have better quality of life because they can benefit from the support and services sooner.

In palliative care what is the overarching goal?

The main point is to ensure patients feel supported, heard, and that their goals match the medical treatment they receive. It’s an extra layer of support so that people facing a serious illness can focus on living as well as they can, having their symptoms managed, and feeling like they have a team working with them, not just on them.

Why do some patients resist palliative care?

Sometimes patients think, ‘If I receive palliative care, I’m somehow giving up.’ But palliative care is truly just an extra layer of support with symptom management, pain control, and emotional support.

It’s about making sure patients feel heard and understood and can live as well as possible for as long as possible.

Could you give an example of how palliative care helps a patient over time?

I have a patient with metastatic breast cancer, and we’ve been seeing her for five years. We work closely with her oncologist. We help manage her pain, nausea, and other symptoms related to her treatments. We see her every few months to check on her physically and emotionally.

Recently, she was able to go on a cruise, which was exciting. We all celebrated that win because she felt well enough to travel. It’s rewarding to know we played a role in making that happen.

Communication must be critical within the are team—oncologists, palliative care teams, social workers, and so on. How do you guard against mixed messages?

We emphasize talking to each other—sometimes by messaging or calling before and after appointments—so that we’re delivering a uniform message. One of the most frustrating things for a patient is hearing different plans from different clinicians. Patients want to know their oncologist, palliative care team, and primary care doctor are talking, agreeing on a plan, and truly working together.

What are some of the outpatient services offered in palliative care beyond managing physical symptoms?

Patients often need help with finances, transportation, or spiritual concerns. We tailor our frequency of visits to their needs—some people check in every few months, others every six months or so.

We also look at how people are coping. A cancer diagnosis is heavy. Support groups, talk therapy, and meeting with our social worker or psychologist can help people process their experience and feel less alone. We want them to know they’re not just a patient—we see them as a whole person. Our team includes social workers, a psychologist, physicians, nurse practitioners, and other specialists.

Hospice near end of life and home care can be a big responsibility for caregivers and families. How are they supported?

Caregivers shoulder a tremendous burden. They’re often juggling work, family, and care responsibilities—sometimes without much backup. We can’t always fix every challenge, but we look at each situation from a bird’s-eye view. We consider how can we involve other family members or friends? Are there resources or grants that can help finance in-home support? Are there local or online caregiver support groups?

Supporting caregivers is crucial because if the caregiver is completely overwhelmed, the patient care suffers, too.

How has hospice care in the hospital changed? Has hospice care shifted to home?

About 95% of hospice patients are at home or outside the hospital. Most people say that they want to be home, if possible and our role is to align care with what patients want.

Hospital hospice units still exist, but Medicare regulations have changed, and those units typically admit patients who need complex symptom management that can’t be provided elsewhere.