The New Face of Palliative Care
Meier, Diane E., Aging Today
One day, years ago when I was a young intern, my pager went off: my 89-year-old patient was in cardiac arrest. One person was doing chest compressions, another was giving electric shocks to the chest. His chart said he'd been hospitalized for three months with end-stage heart failure, and for more than a year, could not walk without oxygen. Yet no one had talked to him or his wife about what was most important to them. No one asked if he wanted to spend his final months in an ICU. Likewise, no one explained to me why we were attempting to restart an 89-year-old's heart with these interventions. But the message was clear-doctors are supposed to prolong life at any cost.
Approximately 90 million Americans are living with serious and life-threatening illness, and this number is expected to more than double over the next 25 years. But studies show that most people living with serious illness experience inadequately treated symptoms; fragmented care; poor communication with their doctors; and enormous strain on family caregivers. Palliative care was developed in response to these inadequacies.
Not Just for the Dying
Palliative medicine, a relatively new medical sub-specialty, focuses on improving and maximizing quality of life-and quality of care-for seriously ill patients and their families. It applies to any patient at any age and any stage of a serious illness, regardless of prognosis. Patients receiving palliative care from the point of diagnosis may live for years with one or more chronic diseases.
An artificial dichotomy exists in our healthcare system: cure versus comfort. The reality is that most people living with one or more serious illnesses need both life-prolonging and palliative treatment. I wrote a recent editorial that related the story of a young woman with leukemia who had originally experienced terrible physical, psychological and spiritual symptoms. Her and her oncologist's goal was cure. She received a bone marrow transplant. Fortunately she responded; six years later, she's still alive. It's worth noting that she received very aggressive palliative care in harmony with very aggressive, effective curative treatment.
A study published in the August 2010 issue of the New England Journal of Medicine showed that patients receiving palliative care along with cancer treatment lived approximately three months longer than patients getting only usual care. They lived longer, and their quality of life, mood and family satisfaction also improved.
Physicians and nurses tend to specialize in one disease, organ system or procedure. Taking care of the whole person and family during a serious illness is something most clinicians neither have the training nor time to do. Palliative care teams (at a minimum, palliative medicine physicians, nurses and social workers), though, have the training and skills to care for the most complex patients and their families.
Palliative care specializes in comprehensive symptom management, intensive communication and care coordination that addresses the episodic and long-term nature of serious and chronic illness. Patients being treated by palliative care teams, together with the primary team, benefit from well-controlled symptoms, improved patient-physician-family communication and satisfaction with their care.
Hospitals and Palliative Care
Hospital palliative care teams enhance the efficiency and effectiveness of hospital services, thereby reducing costs. …