Friday, February 10, 2012

Palliative Care Anyone?

Two bits and pieces converge - suggestions to make palliative care primary - when cancer is diagnosed and in place of current hospice programs.

ASCO suggests that in treating some cancers, palliative care should be made available immediately upon diagnosis.

In the same month, former hospice director Hunter Groninger, MD (now at NIH in the Pain and Palliative Care Service) suggests that home-based palliative care may be an alternative approach to the current Medicare-funded limited hospice benefit . He writes:

"A more radical approach might replace the hospice benefit with home-based palliative care, similar to the model studied by Richard Brumley and colleagues and described in the July 2007 Journal of the American Geriatrics Society. Patients with advanced congestive heart failure, cancer, or COPD were given symptom-focused interdisciplinary supportive care at home that was similar to home hospice care, but with important differences. Under the program, patients could participate if their expected life expectancy was less than twelve months, rather than six; they could continue receiving disease-modifying therapies; and the palliative care physician actively coordinated care among all of the doctors involved, to help diminish fragmented care. The results? This home-based palliative care intervention greatly reduced the costs of care, prevented hospitalizations and emergency department visits, and improved patients’ satisfaction."

Our current approach to end-of-life care is stymied by the lack of prognostic certainly -- we just don't know when someone is going to die and we don't provide palliative care services throughout an illness because no one knows if it's really the "last illness" or just one more illness along an excruciating long road to that last illness.

The current suggestions (providing palliative care immediately upon a cancer diagnosis and in place of the time-limited hospice benefit) are progressive, creative, and deserve a closer look


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