Thursday, April 15, 2021

Palliative Care

Environmental & Science Education, STEM, Health, Medicine, Society

Ed Hessler

There can be confusion about two medical approaches to caring for seriously ill patients with care for those who are dying. Physicians and patients/families of patients often don't quite have the details straight.

Palliative care according to R. Sean Morrison and Mireille Jacobson in a recent STAT First Opinion, is "a team of specially trained doctors, nurses, social workers, and chaplains who focus on improving quality of live and reducing the disease burden for seriously ill individuals and their families." Hospice, on the other hand, is "care for those who are dying, which focuses on comfort." The link describes hospice care in detail and you can see why there might be some confusion between it and palliative care.

Palliative care works, i.e., it has been found in several studies to have beneficial results, notably in cancer but also other studies. And it the authors note is an endorsed plan of action from the American Cancer Society and the American Society of Clinical Oncology. So why is it not used more frequently? The writers ask that we simply "follow the money." 

Morrison and Jacobson note two reasons which are greatly shorthanded below.  As usual take a look at the essay for details.

--To provide palliative care requires "an upfront investment by hospitals and health systems."

--Palliative care reduces "unnecessary hospital admissions or emergency department visits due to better symptom management, along with reduced spending due to better care coordination."

The result is clear. Physicians and health care systems are unlikely "to act against their own financial interests."

So what can be done?

--Medicare "needs to incentivize physicians and financially reward health care institutions for providing high-quality palliative care." In addition, reporting methods to Medicare must provide data to "capture reductions in symptom burden" to ensure that hospitals that meet these standards are paid for their services.

--Changes in the curriculum of  medical education need to be made, e.g., "adding questions about palliative care into medical student and physician board exams," and of course continuing education on palliative care for both the licensing of physicians "and hospital credentialing."

The authors note that in 2034, the United States will have more of its residents age 65 and over, a "group at highest risk for cancer and other illness--than under the age of 18." This age group will "develop one or more serious illnesses they will live with for many years." Palliative care is a proven treatment option "that can increase quality of life and longevity." Everyone must have access to it.

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