by Porter Storey, MD, AAHPM Executive Vice President
Palliative care teams should be consulted more often for cancer patients in active treatment.
I know, I am “preaching to the choir” on this blog, but it may be important how we explain this to our various “stakeholders.”
The Public – Palliative care can help align patient wishes with their treatments and make sure patients and families are comfortable and supported.
Patients – Palliative care can help with symptom management, care coordination, psychosocial support so that you can continue your treatment and continue to do so after it is completed.
Hospice Programs – Palliative care can provide support before they qualify for hospice and refer patients to hospices sooner, for longer lengths of stay.
Payors and Program Administrators – Palliative care consultations can reduce costs and improve quality for the sickest (and most expensive) patients we care for. It can reduce hospital readmissions and save thousands of dollars per hospitalized patients (for the latest of many articles see Nelson C, et al. Inpatient Palliative Care Consults and the Probability of Hospital Readmission. Permanente J. 2011, 15(2):48-51.)
Referring Oncologists – Palliative care can act as an extension of the oncology care team so oncologists can focus on giving treatment. And as Tom Smith and Bruce Hilner argue in the May 26 NEJM, “bend the cost curve” so that we can afford to offer expensive new treatments to patients who can benefit from them (N Engl J Med 2011; 364:2060-2065).
Let’s not apply the wrong argument to the wrong class of stakeholders.
What do we say to the politicians?
Join the discussion when AAHPM offers the webinar “Changing the Mindset: Integrating Palliative Care into Cancer Treatment” lead by Tom Smith on Tuesday July 14 at 3pm ET.
I have found it difficult with most oncologists to even consider consultations with palliative care,and frequently they only refer to hospice hours or days before death. This is not to say all in the discipline, just the majority that I have worked with. After the NEJM article, I made a major presentation to our CA committee and suggested that as each new CA patient was diagnosed that we have a meet and greet consultation, so that patient’s knew about us, and that we were here to make their treatment to cure easier and provide support for mind and body for them and their families. While the presentation was well received, the referral patterns didn’t change at all!
I now focus on teaching the Junior medical students what Palliative medicine really is and have created mnemonics( every discipline has to have them, right?) And when asked by patient and/or family what I can do for them? I use the analogy of the Hostage Negotiator. I am there to help the patient negotiate with their family and medical team,(PCP and frequently long list of dueling consultants) shifting through all the confusing information, and do my best to get them the best possible deal in terms of comfort and solace, both physical, spiritual and existential(although I don’t use the big words. I’m, thinking of getting hats and windbreakers printed.
What do we say to politicians, mandate third party payors to pay us and insist that this is a necessary service that all Cancer centers need to provide! Would you want your pain management to depend on the average surgeon, and many oncologists think Zofran is the sin qua non for nausea. Again I don not mean this to bash another group of excellent specialists. Oncologists never give up in a field that would depress many otherwise fearless folks, and because of this cure rates have improved. Surgeons have to have nerves of steal to operate when they are swimming up stream against the current. Each of our chosen disciplines at times gives us a tendency toward tunnel vision, so we must always listen to each other. But it must be a two way street. We cannot always be the ones to listen and respond, the other side has to do the same!