Once Seen as an End-of-Life Specialty, Palliative Care has Moved into the Mainstream
“It is not death that a man should fear, but he should fear never beginning to live.”
– Marcus Aurelius
For David R. Barile, MD, a geriatric medicine specialist based in Plainsboro, NJ, it was the steady calm of one of his patients – a grandmother and a woman diagnosed with a terminal illness that reinforced his vision of the promise of palliative care.
Faced with a life-threatening illness, she most likely was looking at weeks of chemo and radiation therapy that may or may not cure her. But either way, the treatments would sap her strength and make it extremely difficult to carry on with everyday activities she enjoyed.
But there was one more thing. No matter what, she did not want to do anything that would cause her to miss her grandson’s bar mitzvah. The best approach for helping her achieve her goal of living life the way she wanted? Palliatve care, which focuses on providing relief from the symptoms and stress of a serious illness.
A Question of Choice
For many doctors, the idea that a patient would choose to exert such a strong influence on her course of treatment might sound unusual. But to Dr. Barile, that kind of insight is something that has been lacking for too long.
Dr. Barile is also the founder and Chief Medical Officer for Goals of Care Coalition of New Jersey, an interdisciplinary partnership of leaders representing healthcare providers and systems, government agencies, and community organizations whose mission is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness and to document their preferences in a care plan. Increasing awareness about benefits of palliative care is a key part of the effort. Recently, Dr. Barile discussed the topic of palliative care as a featured speaker at a Health Issues Committee Forum sponsored by the Chamber of Commerce Southern New Jersey. (Note: SPRYTE Communications’ CEO Lisa Simon is a member of the chamber’s board of directors.)
“The Coalition’s fundamental purpose is to organize medical care to help patients achieve their life goals,” explained Dr. Barile. The approach consists of four basic steps:
- Identifying patient goals
- Aligning treatment to achieve those goals
It sounds simple. But as Dr. Barile notes, it’s also somewhat uncommon. More common is the approach of “diagnose then treat.” That works well in most health situations, but falls short in end-of-life care, Dr. Barile says. And for many patients it creates a very stressful and unwanted burden.
What is often lacking is patient input, he says. What are their personal goals? And what kind of treatment plan can be developed that will enable them to meet those goals?
Dr. Ihrig is an internationally recognized expert on hospice and palliative care and a longstanding advocate for treating patients with life-limiting illnesses according to their individual priorities and life goals – incorporating full transparency and quality of life as key values in their care programs.
His TED Talk, “What We Can Do to Die Well,” urges doctors to focus not so heavily on clinical interventions at the expense of overlooking patients’ overall quality of life and helping them navigate serious illnesses from diagnosis to death with dignity and compassion.
According to Ihrig, at its best, palliative care is meant to be an empowering force for patients, taking into account each patient’s perception of what it means to live with a severe, chronic, potentially fatal condition and helping them live their lives with the highest quality possible.
Both Drs. Barile and Ihrig believe more needs to be done to incorporate end-of-life issues into medical training, so healthcare professionals can better recognize what is happening to their patients. Better training will also enable them to communicate more effectively with their patients, help them achieve informed consent in their decisions, and mutually agree on a treatment program that will meet patients’ personal goals while providing a better quality of life.
“We need to work on the language for end-of-life care,” Dr. Barile says, noting that news stories about former First Lady Barbara Bush reported that she had “stopped treatment.”
“Palliative care is a treatment. But the range of treatment options available to patients needs to be better explained,” he says.
More Cost Effective
There’s an added benefit. According to a study publishd in April by the journal JAMA Internal Medicine, patients with serious or life-threatening illnesses who have palliative care discussions with their doctors at the beginning of treatment focusing on improved quality of life, managing pain and defining goals often experience shorter hospital stays and lower costs.
The JAMA study found that overall, for patients who received palliative care, hospitals saved an average of $3,237 per patient over the course of a hospital stay compared to patients who did not. Hospitals saved an average of $4,251 per stay for cancer patients, compared to an average of $2,105 per stay for non-cancer patients.
Their conclusion: “Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.”
Higher quality care with lower costs. Perhaps an idea worth looking into.