• Promise and pitfalls of palliative care

    Interesting piece in the LA Times on the promise and pitfalls of palliative care.

    • In the promise category, increasing evidence of palliative care effectively dealing with the symptoms of patients and helping them to navigate  the system.
    • In the negative category is uncertainty about how such care will be financed, and workforce needs.
    • In the insanity category is the degree to which our culture cannot have a reasonable discussion about anything related to death and asking hard questions such as “is this treatment worth it?” Palliative care tends to ask this question so will take lots of political heat.

    There is a great need to communicate the reality of what palliative care is: care that addresses symptoms and helps patients focus on goals of care regardless of prognosis. Palliative care is not synonymous with hospice, though the two are related often confused (all hospice is palliative care, but all palliative care is not hospice). And in such confusion, there is a great deal of political mischief that is enabled (death panels, etc).  However, the onus is on palliative care advocates to make the case. As Eric Widera blogged over the weekend, if Siri doesn’t know the difference between hospice and palliative care, then we have lots of work to do.

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    • We do have lots of work to do. I recently heard a helpful metaphor about palliative care from Sean Morrison (director of the National Palliative Care Research Center). He said that talking about hospice and palliative care is like “talking about apples and fruit”. Palliative care can be given throughout the course of a disease, while hospice care (a subset of palliative care) is given at the end of life.

    • @Melissa G
      analogy makes sense. I am struck by how much discussion of quality of life is drowned out, both in the practical discussion of treatment options in some family circumstances, but also in policy and political discourse. The root issue I think is a cultural inability to directly address the idea of limits in medicine and death. Almost impossible to address these in the midst of political toxicity we see in health reform.

      • I believe there is a connection between the resistance to limiting cancer screening tests and the reluctance to accept the inevitability of death with comfort care as a treatment option. As TIE has noted, one of the worst “death panel” offenders is Newt Gingrich, who raised the same fear flag about the PSA screening recommendation as he did about the EOL discussion payments.

        The notion that cancer screening could cause more harm than good is counter-intuitive to many, as we’ve all been excessively exposed to anecdotal accounts of people whose lives were “saved” by early Dx due to screening. The notion that palliative care (symptom management) could be beneficial from the early stages of treatment for a potentially life-threatening illness is similarly counter-intuitive; if you don’t focus 100% on cure, you’re somehow on the side of death.

        • @BillNRoc
          I think you are correct. We need to change this. It is really a cultural shift that is needed. No technical way to do this.