Palliative Care: ‘The Secret Weapon Hiding In Plain Sight’
Diane Meier wanted to talk.
The renowned geriatrician, professor of medical ethics, and director of the Center to Advance Palliative Care read my article in Forbes and was concerned. “Everyone is going to think palliative care is only for people facing the end of life,” Diane told me. “That’s not true.”
I re-read my article and realized that Diane had a point. I had written my piece in order to convey that, as clinicians, we don’t always put enough emphasis on the fact that much of what we clinicians offer does not cure disease – it manages it. I believe this is especially true when it comes to older patients and those with a range of serious chronic illnesses, for whom some of our medical interventions do a lot more harm than good. Rather than chasing low yield, high risk interventions, we should help our patients learn to live well despite chronic illness, help them find enjoyment and pleasure in the things that matter most, and provide them with the knowledge they need to make informed decisions.
And that is where palliative care comes in. Generally speaking, palliative care offers specialized medical care for anyone living with a serious ailment, with a focus on expert symptom management, skilled communication, and support for patients and their families. It is provided at the same time as all other medical care and its aim is to provide relief from the symptoms and stresses of illness, improving quality of life for both patients and families.
What’s more, seniors are by no means the only patients who face severe illness. Consider the case of Rae Anne, for example. She’s a working mother of twins who developed Stage 4 head and neck cancer when she was in her mid-40s. Rae Anne underwent several rounds of chemotherapy and 35 radiation treatments. And then, Rae Anne’s oncology team told her to wait at home for three months until her next scan to see if the treatment worked.
There is also a growing body of evidence that suggests palliative care can lower out of pocket and societal health care costs — and not just for the oldest and most frail people. A recent study published in JAMA Internal Medicine found that hospitals saved more than $3,000 per patient on average when they added palliative care to their treatment. Another study of cancer patients found that the addition of palliative care reduced the cost of care by more than $2,700.
These studies largely looked at patients who were undergoing expensive hospitalizations. But as I pointed out in my previous article, models that bring palliative care into the home prevent symptom crises, thus helping patients avoid the hospital altogether. This allows people to stay in control in their own homes, avoid the risks of hospitalization, and – as a side effect of better care, results in significant cost savings.
This makes sense. When patients experience symptom distress or side effects of their treatments, they often call their doctor’s offices. For more than half the day, a recording will tell them to call 911 in a medical emergency. But the support offered by palliative care teams can help patients navigate their illnesses more smoothly without dialing 911. “Palliative care came in with the monitoring that I needed…if I had a question, my phone call would be returned,” says Rae Anne.
“Palliative care is the secret weapon hiding in plain sight for people living with serious illness,” says Diane Meier. I agree. Whether it’s with an older patient managing comorbidities or a younger patient dealing with an unexpected diagnosis, palliative care can improve people’s qualities of life by providing them skilled and responsive care while helping to rein in costs for patients, families and health systems.
It’s time to make this secret weapon less of a secret.