Page 15 - Delaware Medical Journal - April 2017
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PALLIATIVE CARE
• Reduced use of life-sustaining treatments near death • Earlier hospice referrals
• Care that is more consistent with patient preferences • Improved bereavement outcomes for family
Many people falsely think palliative care is medicine for the terminally ill or for those with end-stage disease. However, more literature is proving that palliative care should start at the time of diagnosis of any serious illness. Not only does this lead to a better quality of life throughout the disease trajectory, but a palliative care intervention can also potentially lead to longer survival.
A landmark study in 2010 of non-small cell lung cancer patients looked at the difference between patients who received palliative care at the time of diagnosis and those who received routine cancer care. Though participants in the early palliative care arm received less aggressive care at the end of life, the median survival of participants in this arm of the study was 11.6 months, compared with 8.9 months for those who received standard care (p = 0.02).3
of the surprise question: “Would I be surprised if my patient died within the next year?” This simple question has been shown to have health status.4
As the evidence to support early palliative care accumulates, it is clear that early discussions regarding disease prognosis are a crucial choices and goals of care.
At this time in Delaware, palliative care is primarily accessible only
to access. As recently as 2011, Delaware received a grade of “F” from the Center for Advancement of Palliative Care (CAPC) for access to palliative care. In 2015, Delaware brought this rating
up to a “B,” with palliative medicine programs in three Delaware hospitals; however, there is still work to be done, especially in the outpatient and home settings. The CAPC report card only looked at inpatient hospital programs.2
The demand for palliative care specialists is growing rapidly, as are fellowship programs. Increasing demand for palliative care can outstrip the ability of specialist providers, and many elements of palliative care can be provided expertly by primary care clinicians, regardless of discipline.5 Primary palliative care refers to the basic competencies required of all physicians and health care workers and is germane to any clinical practice, especially those that care for chronically or terminally ill patients.6 This
is work that is already provided by many of our generalist
standing relationship with the patient is paramount. A generalist plus specialist palliative care model provides the best opportunity to improve the care of all patients, as patients with complex palliative care needs will have more opportunities to access palliative care in multiple settings.
We feel that primary palliative care is a skill that should be taught to medical students and residents and should be a topic of continuing education for providers. We recommend that all generalist providers be able to:
• Know about the trajectory of advanced illness;
• Improve comfort with communication in serious illness;
• Be aware of a patient’s goals of care and what is important to them;
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