Preventive Palliative Care

VS Periyakoil, Senior Associate Editor of the Journal of Palliative Medicine has an interesting post commenting on the release of the Surgeon General’s National Preventive Strategy and noting that it does not discuss preventive palliative care. I have not heard the phrase ‘preventive palliative care before’ but what Dr. Periyakoil notes makes sense:

A major problem in the current and conventional preventive approach is that it only addresses disease and  ignores  person centered care and wellness from the experiential point of view ( it is symptoms that form the cornerstone of the illness experience for patients and their families).

In this context, palliative care is defined as is specialized medical care focused on relief of suffering and support for best possible quality of life for anyone with any type or stage of serious illness.

He goes on to provide a basic definition of preventive palliative care:

1. To conduct routine screening of all patients with serious  illnesses for widely prevalent symptoms like pain, fatigue, anxiety, depression, insomnia and others. Once identified, these distressing symptoms should be charted in electronic medical records so that they can be tracked systematically on an ongoing basis. All subsequent care-plans should include strategies for alleviating illness related symptoms and promote wellness and quality of life.

2. To provide all persons who interact with the health care system with tools and education to do advance care planning and help and support them in this process.

As the policy questions in the health system increasingly turn to focus on value of expenditures, or linking cost with outcomes and quality, palliative care will increasingly move to the fore. Dr. Periyakoil paints a broad vision of palliative care as focusing on symptoms and helping patients refine their own goals of care, and not only focusing on ‘end of life’ issues with which palliative care is most typically associated. The biggest barrier to moving ahead in this area are cultural and political difficulties. I would sum it up like this: will we grow up and learn to ask hard questions and to acknowledge limits in medicine?

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