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Palliative Medicine Suffers An Identity Problem

Palliative medicine suffers from an identity problem. That assertion comes from the authors of a new editorial published in The New England Journal of Medicine who determined that 70 percent of Americans describe themselves as “not at all knowledgeable” about palliative care.

Palliative medicine is usually provided to the terminally and seriously ill in order to treat the symptoms and side-effects of disease and aggressive treatments. The goal of palliative care is not cure, but symptom management.

Palliative Care & Rehabilitation Medicine, MD Anderson, Texas
Palliative Care & Rehabilitation Medicine, MD Anderson, Texas

“Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment,” according to the Center to Advance Palliative Care and the American Cancer Society.

Because palliative medicine is specialty care most often provided by expert clinicians only when life-prolonging medicines have failed, other seriously ill patients and doctors tend to overlook it. “Limiting specialty palliative care to those enrolled in hospice or admitted to the hospital ignores the majority of patients facing a serious illness, such as advanced cancer, who have physical and psychological symptoms,” the researchers write. “We believe that palliative care should be initiated alongside standard medical care for patients with serious illnesses.”

Palliative care experts from Harvard Medical School, Massachusetts General Hospital, the American Cancer Society and Johns Hopkins University co-authored the editorial.

It is vital for patients and doctors to understand the differences between palliative medicine and hospice care. The Medicare hospice benefit provides hospice care exclusively to patients willing to forgo curative treatments and who have a physician-estimated life expectancy of 6 months or less. Palliative medicine is not limited by life expectancy. It also is not dependent on a patient’s preference for curative treatment.

“Several clinical trials have shown benefits of early specialty palliative care in patients with advanced cancer,” the researchers explain. “The effect of early specialty palliative care in other patient populations is less well studied, but there are data suggesting a beneficial role in patients with multiple sclerosis and congestive heart failure.”

However, there is concern that political debates over “death panels,” physician-assisted suicide and reimbursement for advance care planning have made policymakers reluctant to devote resources to initiatives associated with death and dying. “National Institutes of Health allocations for research focused on palliative care remain far behind funding for procedure-oriented specialties,” the researchers add.

Their conclusion: palliative care should no longer be reserved exclusively for patients who have exhausted other options for life-prolonging therapies. “Early provision of specialty palliative care improves quality of life, lowers spending, and helps clarify treatment preferences and goals of care for patients with advanced cancer,” the researchers offered.