Caring instead of curing: Recognizing palliative care need before it’s too late
Ben Franklin said, “You may delay, but time will not.”
In no case is this saying more appropriate than when preparing for the end of life, where ample research supports the benefits of earlier preparation.
For example, an analysis of metastatic cancer patients suggests having discussions about dying two-months instead of one-month before death more than doubled the likelihood of patients dying in a more comfortable, less costly setting than a hospital.
In another study, cancer patients experienced a better quality of life and lived longer when they received palliative care, a less aggressive component of end-of-life care, within eight weeks of diagnosis. Also known as “comfort” care, palliative care focuses on providing critically ill patients and their families with relief from the physical and mental symptoms of serious illness.
But even with the benefits documented, end-of-life preparation continues to occur much later than it should, if at all. In 2013, 62 percent of hospice patients received palliative care for less than a month, while barely a quarter of adults have an advance directive expressing their end-of-life care wishes.
It comes as no surprise that despite the efforts of care providers, end-of-life care in the U.S. is not where it should be. According to a February 2015 study in the Annals of Internal Medicine, the number of people experiencing pain, depression or periodic confusion in the last year of life significantly increased between 1998-2010.
Lack of clinician communication about palliative care use – both with patients and families, and among each other – is a major reason for this increase. We have the world’s best doctors, equipped with advanced medical technologies and treatments. Wired to “do everything always” to find a cure, they’ve become experts at keeping people alive longer.
Unfortunately, a cure isn’t always possible; in these cases, the focus needs to be on managing a person’s physical and emotional states, instead of curing a patient. It’s an unpleasant conversation no matter who you are or what you do, but our society looks to physicians to guide us when it comes to matters of our health, no matter what the situation holds.
Though some research may paint a less-than-positive picture about end-of-life care in this country, progress is being made at many hospitals and health systems across the country.
Take UPMC-Hamot, part of the University of Pittsburgh Medical Center system. The Erie, Pa.-based hospital developed a checklist based on an A-B-C-D-E algorithm. The checklist is used by doctors to clearly communicate a patient’s prognosis and potential next steps with the patient and their family members, and with the care team. This approach has been shown to better set the stage for the use of palliative care, and help ensure end-of-life wishes are honored.
Sometimes the issue is identifying when palliative care is the best approach. With no standard industry-wide guidelines to indicate when to implement palliative care, recognizing the need can be a challenge. This is where technology can help guide the process.
At the Yale New Haven Health System, doctors and nurses use predictive analytics from PeraHealth to improve understanding of when patients can benefit from palliative care. Physicians are data-driven by nature. The software presents trended patient data, offering a real-time visual picture of a patient’s evolving condition during current and previous hospital stays. Having this information provides a context for Yale clinicians to facilitate conversations and make recommendations about the need for end-of-life care.
Our life expectancy is continuing on an upward climb. The number of Americans over the age of 85 is projected to double by 2030, but so is the prevalence of chronic conditions. In other words, we’re living longer, sicker lives. As a result, the need for end-of-life care will only grow.
We can never be too early when it comes to preparing for the end of life, but we can be too late. Having conversations about death too close to the end of life delays needed care that can reduce physical and mental pain and suffering among patients and their families.
To truly make sustained improvements in end-of-life care, it’s time for providers to better understand and communicate when palliative care is the best option; the use of technology and analytics is helping them do just that. They owe it to patients and their families, they owe it to their care teams and they owe it to themselves.
Stephanie Alexander is a 30-year veteran of the healthcare industry, recognized internationally for her work in standardized performance measurements for hospitals and health systems. She currently serves as CEO of PeraHealth, Inc.
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