Palliative care: An idea whose time has come
By: Jackie P. Fournier NP, C. ACHPN
Shirley lives with her husband and is constantly surrounded by her grandchildren. They give her joy. Despite ebbing energy, she insists on being surrounded by them. Shirley has been living with throat cancer for about a year. She has received all the established cancer treatments including surgery. Shirley can’t talk but she can express her needs, desires, and loves very easily. I am fortunate enough to care for her in outpatient oncology. I am a palliative care nurse practitioner.
Frequently, palliative care teams are asked “what is palliative care”? Dr. Cicely Saunders and Dr. Balfour Mount are credited for establishing the foundation of palliative care. Dame Cicely Saunders, a nurse, social worker, and physician established the discipline and culture of palliative care. Dr. Mount, a Canadian urologic oncology surgeon coined the name, “Palliative care” to define a specialized healing approach for patients and families dealing with serious illnesses. Each explored the essence of caring through curative care or when a cure could not be attained. At any stage of an illness, palliative care (PC) provides relief of symptoms affecting QOL and offers an extra layer of support to patients, families, healthcare teams, and PC partners1.
In the early 1980s, PC services for patients with cancer were acknowledged as a needed and essential health service2. Serious illnesses with high mortality rates, like heart failure, prompted the American Heart Association to call for PC integration into routine heart failure management3. PC can improve patient-centered outcomes and reduce hospital costs and admission rates. Among patients with lung cancer, those with PC involved had fewer depressive symptoms, lower rates of aggressive treatment at end of life (EOL), and greater family and caregiver satisfaction4. In patients with COPD who had an unpredictable disease trajectory, early PC involvement and regular discussions reduced emotional angst, provided time to digest information, and an opportunity to understand the illness5. Despite research supporting the benefits of early utilization of PC services, misconceptions persist that PC is only to be used at EOL5.
So, the obvious question is, “why do delays in the utilization of PC services persist”? One barrier to the appropriate use of PC may be the name itself. The term PC evokes confusion and fear because of perceived links to active dying or hospice3. Another barrier may be the referrer’s lack of knowledge regarding what PC provides. Despite growing populous needs, the lack of PC providers may also be a barrier to PC referrals5, 6. The PC model focuses on the biopsychosocial needs of those with serious, chronic illness and their families. Palliative care affords an extra layer of support across all healthcare settings that provides an opportunity to optimize care and clarify the goals of care.