Did you know that palliative care is deemed the fastest-growing medical specialty in the U.S.? This is largely due to our aging population, as well as recognition by payers, providers and policymakers of its proven ability to improve quality and reduce costs.
However, palliative care is still a relatively new movement, considering the long history of healthcare. In light of Advance Care Planning month, here are three points of background:
1. Palliative care is interdisciplinary care (medicine, nursing, social work, chaplaincy and other specialties when appropriate) that focuses on improving the quality of life for persons of any age with a serious illness, as well as for their families.
2. Similar to a patient-centered medical home, palliative care focuses on sophisticated care coordination and added support to patients, their loved ones and treating clinicians. Ideally, palliative care is initiated at the time of diagnosis and is provided concordantly with all other disease-directed or curative treatments.
3. Palliative care is not limited to direct medical care. It includes help in accessing community services, obtaining affordable healthcare and living assistance at home, ensuring a safe environment in the home, and determining what is most important to a patient’s quality of life and how those goals might be achieved.
While palliative care is a relatively new concept to the world of medicine, it has been increasing in the prevalence. And this may be one factor influencing reduced mortality rates within hospitals.
Unfortunately, there is a significant misunderstanding about what palliative care is among patients and providers. A 2011 survey of 800 adults, commissioned by the Center to Advance Palliative Care, found that 70% were “not at all knowledgeable” about palliative care. But once informed, a similar percentage believed that it was “very important for patients with serious illness to have access to palliative care at all hospitals,” and that such care was appropriate at any age and any stage of a serious illness.
Other specialists too seldom request this service for patients who need it, researchers say. Many still believe palliative care is appropriate only when nothing more can be done to treat a patient’s disease and prolong life. But unlike hospice, palliative care can and should be delivered while patients continue treatment for their diseases.
Because most people with serious illnesses are older, seniors and caregivers should understand that palliative care offers proactive care. Unlike hospice, patients can use it at any point in an illness — many will “graduate” as they recover — without forgoing curative treatment.
In two large, randomized trials featured in New England Journal of Medicine, the combination of palliative care and the usual oncologic care was associated with equal or longer survival, as compared with usual care alone. In another randomized trial of patients with metastatic non-small-cell lung cancer, those assigned to early palliative care not only experienced better quality of life and fewer symptoms of depression than patients receiving standard care, but they also lived more than two months longer. And they reported greater satisfaction with care, experienced less pain and spent less time in ICUs.
This news is great for patients, but palliative care can also help their caregivers if it’s started early enough. One study found that palliative care offered soon after a terminal cancer diagnosis led to better quality of life and fewer symptoms of depression among the caregivers. Early palliative care creates a powerful, positive feedback loop in families facing cancer. Not only do patients get a direct benefit from such care, but it gives their caregivers a positive experience, which may make it easier for them to care for their loved ones.
We still have room for improvement to ensure the use of a palliative care is not the exception, but the rule. A group of Premier member health systems that participate in the QUEST 2020 quality improvement collaborative have been leading the way, creating innovative solutions to expand the use of palliative care. In fact, during a collaborative meeting last year, an Ohio health system shared how they used specialist palliative care teams to improve symptom control, accelerate decision-making and facilitate transitions. In essence, they’ve made palliative care “business as usual.” And, they’ve seen a 39% reduction in re-hospitalizations for patients with chronic obstructive pulmonary disease because of it. QUEST 2020 members share these best practices with each other to accelerate improvement, as well as hone in on how to improve through a series of educational sessions. An upcoming QUEST 2020 educational series is actually focused on palliative intensive care throughout the continuum.
Another development is that policymakers are increasingly paying attention to the benefits of palliative care. For instance, providers face huge penalties when Medicare patients are repeatedly readmitted for chronic or recurrent conditions. Appropriate focus on symptom relief and addressing the needs of family and other unpaid caregivers improves a patient’s ability to remain at home rather than returning to the hospital.
While progress is being made, education around the benefits of palliative care is desperately needed among many audiences, including providers, healthcare leaders and patients. If you want to learn more about palliative care, or specifically the importance of advance care planning, check out my last blog or comment below.
Dr. Madeleine Biondolillo is vice president, quality and safety at Premier, where she is responsible for growth of strategic quality and population health initiatives to support members in value-based healthcare delivery improvement. When she's not working, her hobbies are running half-marathons and volunteering in organizations that support victims of domestic violence.