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Palliative Care: Dying With Dignity

Palliative care helps patients and families cope with the spiritual, emotional, and physical pain and suffering of terminal illness and end of life issues.
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Where is Palliative Care Heading?

Palliative medicine continues to grow and develop considerably in the United States, and it can be considered a relatively young specialty, having become board-certified in 2006 as a sub-specialty of internal medicine. Over the years, interest in palliative care has surged. In fact, today, many American hospitals feature their own palliative care programs, which tend to quickly swell up in demand as soon as they are established.

Because of this increased interest, there is a growing need for more personnel to enter the palliative care field. “I do think we have a dearth of palliative care practitioners now,” Dr. McPherson said. Palliative teams are in constant need of more help, she stressed. Medical directors and physicians who are working for or with hospices can become board certified, referred to as an HMDCB.10

When palliative care teams are fully staffed, the resulting interventions are much more effective at shortening the gap of time between a patient being diagnosed with a serious illness and getting the palliative consultation they need.11 Researchers are finding this to be a prevalent issue with various patient groups, which may not be getting the proper palliative care they require in a timely manner.

HIV patients in urban hospital settings have limited access to palliative and hospice care. For the very few that do enter a hospice program, they die only days later, which suggests these patients need to be identified and treated earlier in their disease.12 The same issue appears in children diagnosed with aggressive cancer, who are not receiving pediatric palliative care (PPC) as quickly as warranted. Researchers now assert that integrating children quickly into palliative treatment is essential for providing a competent holistic approach to their health care.13

On a more positive note, there has been a fruitful relationship forming between palliative and hospice care teams. As a result, the process of transferring a patient from a palliative to a hospice setting is becoming more seamless and intuitive. “We are seeing very strong alliances formed between hospice and palliative care, [and] thank goodness that palliative care will take drugs or dosage formulations that are user friendly and can be used by the patient, like an oral solution (not using the injectables), and they’re cost-effective for the hospice.”

Evidence-based practice is also becoming stronger in the palliative field. Every month, a bevy of new research into palliative topics is published, so much research that Dr. McPherson noted many professionals probably will have trouble keeping up with it all. Of course, there are natural challenges to continuing conducting well-designed palliative investigations. Some doctors become gatekeepers, and may feel that the research uses too vulnerable a patient population or even is detrimental to their well being. Such attitudes can be a hindrance to palliative care research.14

As the literature continues to grow, palliative care professionals can employ more clinical evidence to support their treatment decisions, Dr. McPherson noted. As essential as it may seem, there was a time when scant research even supported the cost-effectiveness of palliative care. Now, a wide range of peer-reviewed original investigations show that inpatient palliative care (IPC) lowers health care costs, reduces readmission rates, and improves patient satisfaction.15,16

“There has been such an explosion in the research on the appropriate usage of interventions on people with a life-limiting illness,” Dr. McPherson said. “When you consider that hospice and palliative care is about 40 years old, relative to the field of internal medicine, which is about 3,000 years old, it’s just amazing where we’ve come from and where we are now.”

Pioneering Palliative Approaches to Care

Palliative care professionals are continuing to develop novel techniques to improve and broaden the range of services offered to patients with advanced illnesses. For instance, researchers have been exploring the effects of music as a form of pain therapy for patients with cancer and have been finding positive results when music is included with analgesic therapy.17,18

However, music may not be the only creative medium worth offering to palliative and hospice patients. For the last 9 years, the not-for-profit MJHS Hospice and Palliative Care organization in New York City, has run an Art & Soul™ Creative Arts Therapy program, where patients, family members, and friends can participate in art and music programs led by trained music and art therapists. The program includes painting, storytelling, or just listening to music, and has been shown to reduce pain, anxiety, and emotional distress and improve QOL.19 These types of programs can be found in most palliative care centers, Dr. McPherson noted.

Language barriers are another relevant issue palliative care professionals face when treating a patient whose native tongue is not English. This can make basic communication significantly difficult to achieve during sensitive EOL discussions between a patient and caregiver, in part because some languages such as Spanish don’t have clear translations of words like “hospice.”

Now, palliative care teams are beginning to integrate professional medical interpreters to improve communications with limited English proficiency (LEP) patients. This strategy can make a difference, because patients who are counseled with the help of such interpreters become better informed about their symptoms and are better able to make treatment decisions that are aligned with sound palliative care goals.20

Many of these new developments in palliative care have a common thread: providing the best possible support by not only using established end-of-life care techniques, but also taking that extra step to help the patients and caregivers cope with even the basic challenges of everyday life. Dr. McPherson described going so far as to teach a woman how to balance a checkbook, so her ailing husband could rest a little easier.

And perhaps it is this “get-it-done” attitude that makes palliative care professionals such valuable assets to the medical field. Doctors who are exposed to the benefits of palliative care are beginning to experience a shift in how they view patients; they are beginning to appreciate the benefits of providing a more relational, versus, a transactional, approach to care.21

For Dr. McPherson, those relationships seem to be the most rewarding part of her job—the experiences she has had with the people she has helped, and the humility they have given her through her 30 years in the practice. “It’s the most humbling, gratifying job—I’ve done many, many things in the field of pharmacy and this takes the cake. People say they want to go into health care because they want to make a difference. I make a difference every single day.”

Last updated on: February 9, 2016
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Pain Management in a Palliative Care Setting
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