The Impact and Benefits of Palliative Care This is the second in a series of three articles. Years of research and patient accounts tell us that the care of patients with serious illness – both during ongoing treatment and at the end of life – may be fraught with unmet needs. Pain, shortness of breath and delirium are frequently under-recognized or under-treated. People facing serious illness often receive care in the last phase of life in places and in ways not consistent with their wishes.1 Higher-intensity and higher-cost health care actually correlates with worse quality of life at the end of life.2 Moreover, families and loved ones often feel lost, confused or unsupported during these difficult events. There is a better way. With emphasis on symptom management, communication, advance care planning, coordinated care by the interdisciplinary team and family/caregiver support – palliative care helps address many of those unmet needs and aims to buttress a complicated and sometimes dysfunctional care delivery system. Palliative Care Helps Patients
Those who receive it usually experience: - Care consistent with patients’ preferences and values
- Better pain and other symptom control
- Less emotional and psychological suffering
- Better support in making difficult decisions that enable patients to work toward their goals in the course of their illness or condition
- Greater satisfaction with the care experience
- Smoother and safer transitions to other appropriate care settings
Palliative Care Works in All Settings and Can Prolong Life
Though studies all vary to some degree, the effects have been shown in hospital,3, 4 ambulatory5 and home6 settings. For patients at the end of life, hospice care often leads to greater satisfaction with care, enhanced patient and family support – all without a decrease in life expectancy compared with similar patients who do not receive hospice support.1,7 The benefits usually tend to be more pronounced at the end of life, but palliative care helps throughout care of life-threatening disease. As Temel and colleagues showed in a landmark 2010 study, patients with metastatic lung cancer who received concurrent palliative and anti-cancer care at diagnosis reported better quality of life, less depression, better prognostic understanding of their illness and lived longer.8 Palliative Care Helps Families
Finally, patients and families facing serious illnesses is a public health issue, and palliative care can help improve overall outcomes. When communication about a patient’s illness is promoted early and regularly, families and loved ones providing care have better self-reported health outcomes and less depression themselves.9 Moreover, this added layer of support, whether through palliative care or home hospice programs, can be provided with overall cost savings to the health care system – especially in the last phases of life when the cost of care tends to increase significantly.9-12 Palliative Care is Becoming Available
Fortunately, hospitals, health care systems, professional societies and national quality guidelines have increasingly advocated for integration of palliative care across the continuum of care. More than half of the hospitals with at least 50 beds in this country (and over 85 percent of the larger hospitals with over 300 beds) now have palliative care programs of some type.13 The challenge remains how to most effectively and efficiently integrate these services earlier in the care of patients and families facing serious, life-limiting illnesses. We have a ways to go, but as long as patients, families and providers increasingly demand the support, information and care they need, concurrent palliative care will become an expected part of care, rather than an “extra,” novel idea. References
1 Teno JM, et al. JAMA. 2004; 291: 88-93.
2 Zhang B, et al. Arch Intern Med. 2009; 169(5): 480-88.
3 Casarett D, et al. JAGS. 2008; 56: 593-99.
4 Higginson IJ, et al. J Pain Symptom Management. 2002: 23(2): 96-106.
5 Rabow MW, et al. Arch Intern Med. 2004; 164(1): 83-91.
6 Gomes B, et al. Cochrane Database of Systematic Reviews. 2013, Issue 6, Art No:CD007760.
7 Connor SR, et al. J Pain Symptom Management. 2007; 33(3): 238-46.
8 Temel JS, et al. NEJM. 2010; 363: 733-42.
9 Wright AA, et al. JAMA. 2008; 300(14):1665-73.
10 Morrison RS, et al. Arch Intern Med. 2008; 168(16): 1783-1790.
11 Morrison RS, et al. Health Affairs. 2011; 30(3): 454-63.
12 Kelley AS, et al. Health Affairs. 2013; 32(3): 552-61.
13 Center to Advance Palliative Care. capc.org. Accessed Nov. 8, 2013. Dr. Eytan Szmuilowicz, Director of the Section of Palliative Care at Northwestern University Feinberg School of Medicine, has provided this information about palliative care for Blue Review readers. | 
