Friday, August 27, 2010

Guest Commentary: The Promise of Earlier Palliative Care

Laura Kimberly, MSW, MBE
Director of Special Projects
Jefferson School of Population Health

It is well established that palliative care is typically introduced far too late in the course of treatment for a patient with a terminal or life-limiting diagnosis to achieve the optimal benefit. Sadly, palliative care is often regarded as an option of last resort once all other options have been exhausted and further aggressive treatment has been deemed futile. However, palliative care can (and often should) be integrated into a patient’s care far earlier.

In an article published last week in the New England Journal of Medicine, researchers studied a sample of patients newly diagnosed with metastatic non-small cell lung cancer who were randomized either to standard oncologic care, or to a palliative care intervention begun at the time of diagnosis.

The study found that the patients who were randomized to receive early palliative care experienced a better quality of life and improved mood as compared to the control group and survived, on average, approximately 2 months longer than the group receiving standard oncologic care. In addition, patients randomized to palliative care received less aggressive treatment at the end of life with a reduction in utilization of services.

The Western medical model trains physicians to provide the best possible treatment for their patients, making use of every available cutting edge technique and treatment. However, all too often this translates to aggressive, perhaps even futile, care at the end of life that may, in fact, lead to poorer outcomes. Accepting palliative care as an element of an integrated model of care for the end of life requires a shift in treatment paradigm, and these types of culture shifts certainly do not happen over night. However, studies such as this can help to clear up some of the misconceptions that persist regarding the appropriate use of palliative care, with the ultimate goal of enabling patients to approach the end of life with a minimum of distress and suffering, and with dignity and, hopefully, a measure of peace.

I look forward to reading more such studies, and I hope that future studies will also seek to measure improvements in quality of life and mood in caregivers who suffer in their own way alongside their loved ones. If you are doing work in this area, I would love to hear about it and encourage you to contact me by leaving a comment on the blog.

To read this study, please click here.