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 Researchers Study A New Role For Palliative Care

Palliative care has a positive impact on quality of life and symptom burden, according to a new study published in the Journal of the American Medical Association. “The impact on both quality of life and symptom management was both clinically and statistically significant,” says lead author Dio Kavalieratos, PhD, assistant professor of medicine and clinical and translational science in the Center for Research on Health Care and Section on Palliative Care and Medical Ethics at the University of Pittsburgh Division of General Internal Medicine.

“We also saw consistent trends showing that palliative care also is associated with greater satisfaction with care and improved rates of advance care planning,” he says. “Palliative care was able to move the needle for these patients and families at one of the most difficult times of life.”

The study didn’t find an association between palliative care and survival. However, Kavalieratos notes, “there have been several high-profile trials that have shown a connection between the two. One showed that cancer patients lived two to three months longer.”
He stresses that increased survival isn’t a stated outcome of palliative care and that its intent isn’t to help patients live longer. “There needs to be a lot more work on the conceptual underpinning of why we think palliative care would improve survival.”
Palliative care is still a young field, Kavalieratos says, but it has made some dramatic strides. “The majority of large hospitals now have palliative care consult teams that they didn’t have 10 years ago.” But overwhelmingly, he says, “those who receive it have advanced cancer, while other patients with similar burdens don’t get palliative care.”
In fact, many patients could benefit from palliative care but don’t get it. “We hear from providers that they don’t know the right time to initiate palliative care or worry that if they start it, the patient will think they have given up on them,” Kavalieratos says. However, he notes, “The truth is that if we start palliative care earlier and continue it throughout the illness, the patients gets a greater benefit, and it enables a smoother transition when they move to hospice.”
Kavalieratos says, “We need to dispel the myths permeating our culture that palliative care is synonymous with hospice care and that physicians only consider this when patients are actively dying. We have to change the perception of both patients and practitioners.” Everyone needs to understand what palliative care can look like for someone with a serious chronic illness and help providers understand the benefits of this approach, he says.
Fortunately, palliative care increasingly is part of medical and nursing school curricula. “More and more, training includes exposure to palliative care,” Kavalieratos says. “That is a good sign, but it still doesn’t get the attention it should.”
Some policymakers are addressing the issue. In 2013, the House of Representatives introduced the Palliative Care and Hospice Education and Training Act, designed to promote education in palliative care and hospice and support the development of faculty careers in academic palliative medicine. While the bill has not yet passed the House, it represents an acknowledgment that palliative care and hospice have value and have a place in medical and nursing school curricula.
How can post-acute and long term care communities promote the appropriate and effective use of palliative care? According to Kavalieratos, it helps to have an “internal champion,” someone in the organization who recognizes the value of palliative care and is able and willing to train others. “This is a phenomenal way to engender support,” he says. National organizations such as the Center to Advance Palliative Care also are a source of information, tools, and support.
There is another possible benefit of palliative care that warrants additional study, and that is its contribution to lowering costs. Kavalieratos says, “We saw that palliative care was associated with decreased hospital utilization, although we didn’t find evidence that it reduces expenditures. However, there are studies that have shown this, and we didn’t find any studies indicating that palliative care increases expenditures, and that is an important point.”
For more information about this study, go to http://jamanetwork.com/journals/jama/article-abstract/2585979.
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