In the book called Healthcare in 2020 by Steve Jacob, there is a chapter on End-of-Life Care. It provides some great data all sourced there (so not repeated here). I find this whole are of discussion especially around palliative care very interesting.
First, let’s define palliative care:
Palliative care (from Latin palliare, to cloak) is an area of healthcare that focuses on relieving and preventing the suffering of patients. Unlike hospice care, palliative medicine is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases, as well as patients who are nearing the end of life. Palliative medicine utilizes a multidisciplinary approach to patient care, relying on input from physicians, pharmacists, nurses, chaplains, social workers, psychologists, and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient’s life. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual, and social concerns that arise with advanced illness. (from Wikipedia)
The challenge of course is that most people don’t want to talk about dying, and physicians are taught to try everything to cure someone. After talking with a few people working in this area, the general scenario is where clinicians and other social workers are helping to enable to a patient to talk to their family and care team about their wishes. It’s not to make the decisions, but to give patients the tools to have an informed discussion.
Here were some of the interesting things from this chapter in the book:
- Less that ¼ of physicians were familiar with the term in a survey
- The American Society of Clinical Oncology has established a goal of integrating palliative care into its model of comprehensive cancer care by 2020.
- A 2009 study of cancer patients found that palliative care improved patient satisfaction and eased pain, fatigue, nausea, insomnia, anxiety, and depression. And, increased appetite.
- According to the Worldwide Palliative Care Alliance, more than 100M people worldwide would benefit annually from either palliative care or hospice…yet only 8% have access to it.
- The average physician’s estimate of how long a patient will live was 530% too high.
- Fewer than 40% of oncologists speak candidly with patients about end-of-life treatments.
- Physicians equate suggesting hospice as “giving up”.
- A 2008 published study showed that patient satisfaction was higher, more advance directives were completed, fewer ICU admissions were necessary, and medical costs were lower for patients in palliative care.
- Patients with lung cancer that received palliative care lived 3 months longer than those with standard care (which compares to only getting 2-3 months of life from chemotherapy). [BTW – 1 in 5 cancer patients are still receiving chemotherapy in the last two weeks of life.]
- A hospitalized palliative-care patient costs $279-$374 less per day.
- In a Medicare study, patients who received palliative care cost $6,900 less during a hospital stay.
This seems like great data. Imagine that you can improve a patient’s experience in the last months of life and lower costs. To me, that’s a lot of what our healthcare system needs these days.