The number of palliative care programs in U.S. hospitals grew from 632 in 2000 to 1,027 in 2003, an increase of 63%, according to results from a large study.
The study "demonstrates the increasing recognition by hospitals in the United States and those providing primary care for patients with advanced illness of the need for palliative care services," said Dr. R. Sean Morrison, the study's primary author.
"This is becoming part of what should be routine medical care. We have seen growth from a fraction of hospitals having hospital-based palliative care programs to where now 1 in 4 hospitals have a program. I'm not going to be satisfied until 100% of hospitals have [a palliative care program], but for patients and families, I think we're at the point where they do have access to this type of care. I think we are at a tipping point," said Dr. Morrison, vice chair of research in the department of geriatrics at Mount Sinai Medical Center, New York.
He and his associates obtained data from the 2001-2004 American Hospital Association annual surveys, which covered calendar years 2000-2003. The AHA's annual survey defines a palliative care program as "an organized program providing specialized medical care, drugs, or therapies for the management of acute or chronic pain and/or the control of symptoms administered by specially trained physicians and other clinicians; and supportive care services, such as counseling on advanced directives, spiritual care, and social services, to patients with advanced disease and their families."
The researchers identified all programs that self-reported the presence of a hospital-owned palliative care program and acute medical and surgical beds, and then used multivariate logistic regression to pinpoint factors that were associated with the presence of an adult palliative care program in the 2003 survey data (J. Palliat. Med. 2005;8:1127-34).
They found that hospitals in the Northeast, Pacific, and Mountain areas of the country are more likely than those in other geographic regions to have programs. The greater the number of hospital beds and acute care beds, the more likely a facility has a palliative care program. Similarly, being a Veterans Affairs hospital or a not-for-profit hospital increases the likelihood.
Among the factors associated with having a palliative care program are being a member of the American Association of Medical Colleges Council of Teaching Hospitals and being a cancer hospital approved by the American College of Surgeons.
"The fact that the American College of Surgeons would want to incorporate access to palliative care as one of their benchmarks of good care in a cancer setting is a sign that palliative care has been very successful in legitimizing its place in the continuum of medical practice," said Dr. Geoffrey P. Dunn, an Erie, Pa.-based surgeon who cochairs the ACS's Surgical Palliative Care Task Force.
"People are becoming increasingly aware that palliative care is an extension of the already well-known and very successful hospice programs in this country. As this study shows, there are more occasions where they will have the opportunity for those services. I think that's going to increasingly generate that expectation in care, whether it's at a cancer center or elsewhere," said Dr. Dunn. …