Palliative Care, a Rose by Any Other Name?

  If the first things that comes to mind when you hear “palliative care” is “terminal,” you’re not alone.

 Part of the confusion is that hospital-based palliative care in the United States has been separated from home-based palliative care or hospice, which is intended for patients expected to die within six months.

 The stigma remains however.

 “They always say that when you get diagnosed with an illness palliative care is appropriate then, but in practice nobody was getting referred to us,” Dr. Shalini Dalal, from the M.D. Anderson Cancer Center in Houston, said in an interview.

Dr. Shalini Dalal, photo by P. Wendling

In a recent survey of oncology clinicians at the institution, the overwhelming majority perceived the name palliative care to be a barrier to early patient referral. Several other studies have come to the same conclusion.

Although the department is still called Palliative Care and Rehabilitation Medicine, M.D. Anderson opted in November 2007 to change the name of its inpatient and outpatient palliative care consultation service to “supportive care.”

 The composition of the interdisciplinary team did not change nor did their goal of relieving psychological and physical symptoms and enhancing quality of life for patients and their families.

 After the name change, new patient referrals jumped 41% from 1,950 to 2,751 in comparable 18-month time frames, according to data presented by Dr. Dalal at the annual meeting of the American Society of Clinical Oncology.

 The overall increase was driven largely by an increase in inpatient referrals, but something intriguing was also occurring outside the hospital.

 Patients in the outpatient setting were living longer after the name change – a median of 6.2 months from their first supportive care consultation vs. 4.7 months from consultation before the name change.

 Dr. Dalal credits the improved survivorship to seeing patients earlier in their illness. She noted that several leading national organizations including ASCO advocate a simultaneous care model with integration of palliative care services in early stages of the cancer patient’s illness trajectory.

 For those still not convinced, a separate study presented at ASCO may light a fire. To the investigators’ surprise, patients lived longer with metastatic lung cancer when started on palliative care soon after diagnosis. For details of that clinical trial, click here.

 – Patrice Wendling (on Twitter @pwendl)
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Filed under Alternative and Complementary Medicine, Family Medicine, Geriatric Medicine, Hospice and Palliative Care, IMNG, Oncology, Practice Trends

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