Academic journal article Journal of Allied Health

What Health Care Providers Know (and Need to Know) about Palliative Care

Academic journal article Journal of Allied Health

What Health Care Providers Know (and Need to Know) about Palliative Care

Article excerpt

Health care education has been widely criticized for not providing training in end-of-life care. Despite calls from various scientific and professional organizations for formal educational improvement, most education in this area is "on the job." The current project is a secondary analysis of a surveyed convenience sample (n = 608) of health care providers in Kansas to determine knowledge, background, perceptions, and opinions about pain management and end-of-life care. The sample was primarily nurses (73%), with a small representation of other disciplines. The results of the survey indicate that providers believe they are ill prepared to provide palliative care and want professional education to improve knowledge and skills in this area. In addition, they state a need for increased support from insurers and legal and regulatory agencies to provide an acceptable standard of care. Providers responding to the survey also believe there is a significant need for patient education in this area. J Allied Health 2007; 36:209-215.


Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.1

This is not a new approach, and palliative care actually has a long tradition in medicine. A French folk saying dating back at least to the 15 th century roughly translates as "to cure sometimes, to relieve often, to comfort always"*; this can be considered the commission of all health care workers.2

In 1995, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) noted that "Medical culture still tolerates and even rewards the misapplication of life-sustaining technologies while slighting the prevention and relief of suffering"3 and "When the end of life makes its inevitable appearance, people should be able to expect reliable, humane, and effective caregiving. Yet too many dying people suffer unnecessarily."3

In 1997, the Institute of Medicine (IOM) Committee on Care at the End of Life stated that "Humane care for those approaching death is a social obligation. . . ."' It also pointed out that there are many obstacles standing in the providers' way in the fulfillment of this obligation. Among these is lack of formal, appropriate education. This didactic deficit begins in medical school and continues through residency training and continuing education. This leads to serious deficiencies in palliative and end-of-life care. According to the multicenter SUPPORT trial,4 more than half of the physicians caring for seriously ill hospitalized patients did not know their patients' wishes regarding cardiopulmonary resuscitation and that half of do-not-resuscitate orders were written only within the last 48 hours of life. Further, the SUPPORT trial documented less than adequate care in that half of conscious patients spent many of their final days in moderate to sevete pain.

The IOM Committee on Care at the End of Life5 further maintains that "We know that many dying people do not get good care. . . . We can better train the doctors, nurses, social workers and other. . . ." In discussing the current problems, the IOM states that (1) ". . . too many people suffer needlessly at the end of life," (2) ". . . the education of health care professionals too often ignores the dying patient," and (3) ". . . laws, health care systems, and insurance programs sometimes get in the way of good care. . . ." In 2004, the National Institutes of Health released a Stateof-the-Science Conference Statement on Improving End-of-Life Care.6 It noted that

Although considerable research has been done on the use of medications in the management of pain, these protocols have not been widely incorporated into practice. …

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