Extolling the benefits of palliative care
If palliative care were a new cancer drug, it would be hailed as a breakthrough, Diane Meier told a crowd at Christiana Hospital on Thursday.
If palliative care were a new cancer drug, it would be hailed as a breakthrough, Diane Meier told a crowd at Christiana Hospital on Thursday.
Palliative care, which focuses on easing patients' symptoms, supporting families, and discussing patient priorities, not only makes people feel better physically and emotionally, Meier said. It costs less because it keeps people out of hospitals and nursing homes. And, patients live longer.
But palliative care is not a new type of chemotherapy, said Meier, an expert in geriatrics and palliative medicine at Mount Sinai Medical Center in New York City and a MacArthur "genius" award winner. It's what she called "a system-of-care innovation."
Though its profile has risen dramatically in recent years, there's still a long way to go before it is seamlessly integrated into treatment at all levels, a fact she blamed on the nation's massive "medical-industrial complex," which accounts for 20 percent of gross domestic product.
"There's enormous resistance to fundamental change," she said. She's hopeful the Affordable Care Act will speed things up. It rewards medical providers financially for preventing problems, whereas the current system generally pays more for more services.
Meier and David Casarett, director of hospice and palliative care at the University of Pennsylvania Health System, spoke at a conference cosponsored by Christiana's Value Institute and the Delaware Public Policy Institute. It drew a crowd of about 180.
"Medicine is a humanistic discipline at its core," Robert Laskowski, CEO of Christiana Care Health System, said while introducing the speakers. Doctors should aim to "help people live the lives that they want to live."
Though hospice and palliative medicine have much in common, hospice is typically restricted to patients likely to die within six months who are willing to forgo aggressive treatment. Palliative medicine can be used to relieve symptoms of patients at any stage, even if they still want to fight a fatal illness.
Meier and Casarett discussed the growing shift toward palliative medicine in the home and illustrated their talks with stories of patients who ended up in the emergency department with pain because their regular doctors had gone home for the day and there was no other alternative.
"This story is pretty much universal in the emergency department," Meier said. She said doctors tended to blame patients for coming to the wrong place.
"It's not their fault," she said. "It's our fault. It's a system-design problem."
It's natural to think of palliative care for cancer patients, but Meier said those with the greatest need - and the biggest users of care at the end of life - were people with functional limitations, dementia, frailty, and other serious illnesses.
Successful palliative programs target services to high-risk patients, provide phone monitoring and constant access to help via the phone, give good pain treatment, understand that needs will spike occasionally, and talk to patients and families about where things are heading, Meier said.
Many medical professionals are still uncomfortable talking to patients about end-of-life goals, but Meier said they shouldn't wait until patients bring it up.
"They know what's happening," she said. "Anyone can see it. Families know. When we don't talk about it, they're going to feel awkward about bringing it up. . . . It's our job to bring it up."
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