From the annual assembly of the American Academy of Hospice and Palliative Medicine, Boston
During the “State of the Science” plenary presentation here, at least two things became abundantly clear about the hospice and palliative care arena: that a little thoughtful effort goes a very long way toward improving the end-of-life experience for terminally ill patients and their families; and that a little thoughtful effort is often absent.
Dr. Nathan Goldstein of Mt. Sinai School of Medicine in New York and Dr. Wendy Gabrielle Anderson of the University of California San Francisco presented a round-up of some of the year’s top peer-reviewed articles, focusing in particular on research that could have an immediate clinical impact in palliative care and hospice settings.
In the “a little thoughtful effort goes a very long way” category, they discussed the findings of the Project ENABLE II randomized controlled trial that were published in August in the JAMA which showed that patients with advanced, life-limiting cancer who participated in a four-session, group psycho-educational intervention with telephone follow up experienced higher quality of life, decreased depression, and a trend toward reduced symptom intensity compared with usual care. International guidelines and consensus statements recommend the implementation of palliative care interventions concurrent with oncology treatment, and this is the first randomized controlled trial to test the efficacy of doing so, according to the presenters.
Regarding the absence of “a little thoughtful effort,” a study out of Dana Farber Cancer Institute published in the January 20, 2010 issue of the Journal of Clinical Oncology, looked at the provision of spiritual care to nearly 350 patients with advanced cancer and showed that the majority of the patients (60%) reported their spiritual needs were only minimally supported or were not supported at all, and more than half (54%) had not received pastoral care visits. The findings are somewhat astonishing, and heartbreaking, particularly considering the advanced stage of the patients’ disease (the study sample died a median of 116 days after the baseline interview, according to the authors).
Spiritual care is supposed to be a quality standard for palliative care, yet, as this study illustrates, that the standard is often not being met.