Palliative care needs a simple and consistent message-

Posted by: admin on: July 28, 2011

Alex Smith, Assistant Professor of Medicine, Department of Medicine, and Division of Geriatrics at the University of California

  • I was consulted recently about an elderly woman who refused surgery for a large bowel obstruction from a colonic mass, likely cancer. The inpatient team asked me to help with the transition to hospice and to help make her comfortable. When I went to see her, she had a nasogastric tube sucking up brown material from her stomach. Her abdomen was swollen and uncomfortable. Her primary goal was to return to walking about with her walker. I persuaded her that surgery would meet her goals better than no surgery.
  • After considerable discussion, she agreed. What a shock to the primary team! They called a palliative care consult to assist with the transition to hospice, and here I’d gone and persuaded the patient to have surgery.

  • Diane E. Meier, Director of the Center to Advance Palliative Care recently said, “palliative care is about matching treatment to patient goals.” I would estimate that 90% of the time, after engaging in discussion with patients and their family, the treatment shifts to a more comfort oriented and less life-sustaining approach. But 10% of time, as in the case above, the opposite occurs. If 100% of the time the treatment matched to their goals was exclusively comfort-oriented, then we’re probably doing something wrong. We consult to clarify what treatment best matches patient goals, not to convince patients to abandon life-prolonging care in favor of hospice. The former makes us useful and accessible; the later makes us the death squad.
  • Patients, family members, and colleagues ask what palliative care is all the time. I used to give a complicated answer. Now I start by saying, “palliative care is about matching treatment to patient goals.” This is a very straightforward and powerful message. Notice how it differs from other possible messages; “we focus on keeping people comfortable,” “we provide an alternative to aggressive life-prolonging care,” or “have you heard of hospice?”
  • How do you explain palliative care to your patients and colleagues? To your hospital administration? Does your message differ according to your audience, and should it?
  • As a community, we should try and agree on a message. Before others, like those who perpetuate the notion of “death squads,” do it for us.


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