During the healthcare reform debate there was the unfortunate reference to “death panels.” No such thing was ever in the proposals but it meant that an important part of medical care was set aside as too “toxic” to discuss. But end of life counseling is very important. Indeed it is good to have realistic discussions at the beginning of a serious illness; indeed it is only fair to the patient and the patient’s family.
Palliative care (I don’t like the term; it seems to imply only end of life care and so I prefer “supportive care”) is designed to achieve the best possible quality of care and the least suffering possible. This is not limited to pain management but also to psychosocial support, spiritual needs, the treatment of any symptoms, and assistance or at least support for decision making. It might be a complicated pain management program or a simple cup of tea in the afternoon to talk over important issues. Ideally it uses a team approach including physicians, nurses, social workers, psychologists, chaplains and others all working together. Palliative care teams have demonstrated their value in improving care and, interestingly, substantially reducing medical care costs.
There was a recent report of a controlled trail of palliative care. 151 patients with lung cancer entered a randomized trial when they first came to be treated in a thoracic oncology practice. It compared standard care to the same care plus a palliative care team. The results were clear that palliative care added to the patients’ quality of life; reduced the frequency of depression, the number of hospital days and even extended the survival by 2.7 months.
My experience, and others report the same, is that many physicians are uncomfortable with palliative care and tend not to refer their patients or if they do, not until very late in the patients’ course. Perhaps it gets at the deep inner concern that they do not want to be seen as “giving up” on the patient and perhaps it even forces them to admit that they cannot always cure every patient. Whatever, it is unfortunate because many people who could benefit from early referral to the palliative care team are not getting that benefit. Most large hospitals now have such teams; it behooves the patient or family to ask about them.