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Palliative care: it’s the standard of care
e-Reports, July 23, 2012
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When you need help controlling a patient’s pain or managing symptoms, when you lack the time to appropriately educate the family, answer questions and discuss options, a palliative care referral can provide the relief everyone needs.

Yet, confusion abounds – among the public, physicians and other health care professionals – about what exactly comprises palliative care services. Media discourse about “death panels” certainly added to the confusion, but these services can be easily defined as “relieving or soothing symptoms of a disease or disorder,” as done by the American Academy of Hospice and Palliative Medicine.

Ideally, palliative care should be initiated long before a patient with a serious or life-threatening illness needs end-of-life care. In collaboration with other health care professionals, a palliative care team focuses on the impact an illness has on patient and family, giving particular attention to physical, emotional and spiritual discomfort.

But it’s also important to clarify what palliative care is not. It is not hospice care, but a subset of that 30-year-old movement. And palliative care physicians do not take the place of primary care doctors or other specialists; they add another layer of support for the patient.

“We don’t do euthanasia or physician assisted suicide. We give carefully titrated medicine to relieve suffering, not hasten death,” explained Rob Stone, M.D. After working many years in the ER, Dr. Stone started a palliative care program at IU Health Bloomington Hospital in January.

Defining hospice and palliative care
Dr. Stone noted that Medicare defines hospice as appropriate when

1) life expectancy is 6 months or less and 2) a decision has been made to forego curative treatment to focus on comfort and quality of life.

On the other hand, goals of palliative care involve:

  • Reducing the burden of symptoms like pain, nausea and fatigue
  • Assessing and responding to unmet social, emotional and spiritual needs
  • Clarifying goals and outcomes of treatments, considering personal preferences and values
  • Collaborating to establish a comprehensive plan of care for present and future
  • Improving quality of life and relieving suffering

Time to grow
Dr. Stone firmly believes “palliative care is an idea whose time has come.” Here’s why:

  1. Medicine has become so specialized and compartmentalized that everyone is working harder and focusing more narrowly. Palliative caregivers can look at the broader picture and take more time with the patient.
  2. Patients and families love it. That means hospital administrators can see satisfaction scores rise, and increasingly studies show patients and families appreciate this kind of care.
  3. Palliative care can save money for hospitals. At a time when readmissions within 30 days are under scrutiny, palliative care services help keep people out of the hospital. They also help with mortality ratios and overly aggressive care near the end of life.

Room to improve in Indiana
The Center to Advance Palliative Care (CAPC) issues a state-by-state report card to grade access to palliative care services in hospitals. Overall, the nation gets a "B" grade, up from a "C" when the report was first released in 2008. Likewise, Indiana earned a “B” on the most recent report card, an improvement due to expansions like the one in Bloomington.

The CAPC notes that over the last 10 years hospital palliative care teams have more than doubled. “The bad news is that despite its enormous benefits to patients and caregivers, millions of seriously ill Americans still do not have access to palliative care,” said Diane E. Meier, M.D., CAPC director.

For more information
Interested in a palliative care program for your hospital or practicing in this specialty? The Center to Advance Palliative Care has resources, tools, education and training information on their website.

To help your patients learn more about palliative care, suggest they visit the center’s website for patients.

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