Palliative Care is Better End-of-Life Care
Just a few days ago, The New York Times’ Upshot Blog published a piece written by Dhruv Khullar exploring how our society falls short in conversations surrounding death and dying. We’ve explored this idea in previous posts, but because The Upshot focuses more on the data behind their stories, we thought it added some important new context to the conversation.
More Care Doesn’t Equal Better Care
The piece begins with the familiar story of a cancer-stricken woman quickly deteriorating in a hospital’s ICU. She was so unprepared for this unavoidable moment that when her oxygen levels dropped suddenly, she had to make the choice to be intubated for the final time. Khullar uses this heartbreaking anecdote to illustrate the consequences of our collective inability to discuss our own inevitable deaths. This is evidenced by the shocking amount of effort our healthcare system puts into end-of-life care:
Despite growing recognition that more care isn’t necessarily better care, particularly at the end of life, many Americans still receive an enormous dose of medicine in their final days. On average, patients make 29 visits to the doctor’s office in their last six months.
In their last month alone, half of Medicare patients go to an emergency department, one-third are admitted to an I.C.U., and one-fifth will have surgery — even though 80 percent of patients say they hope to avoid hospitalization and intensive care at the end of life.
Medicare spending for patients in the last year of life is six times what it is for other patients, and accounts for a quarter of the total Medicare budget — a proportion that has remained essentially unchanged for the past three decades.
To make matters worse, there’s little evidence these gargantuan efforts make any difference in extending patient’s lives. And all that effort certainly doesn’t guarantee those final days will be any more satisfying for the patient or their family. According to the author only “[t]wo interventions have consistently been shown to help patients live their final days in accordance with their wishes: earlier conversations about their goals and greater use of palliative care services…”
Advance Planning and Palliative Care Lead to Better Outcomes
According to the author:
Patients who engage in advance care planning are less likely to die in the hospital or to receive futile intensive care. Family members have fewer concerns and experience less emotional trauma if they have the opportunity to talk about their loved one’s wishes.
In addition to planning ahead, “earlier access to palliative care has consistently been linked to fewer symptoms, less distress, better quality of life — and sometimes longer lives.” So what’s holding us back from fully pursuing these interventions? It’s complicated.
Access to hospice and palliative care is growing in the United State but not every region of the country is equal. For example, 90% of the hospitals in the northeast offer palliative care compared to only 40% in the south. Research also shows that racial and ethnic minorities are less likely to receive palliative or hospice care and, as a result, are more likely to receive aggressive hospital care in the last six months of their lives.
The author also notes that many seriously ill patients don’t receive palliative or hospice care because their illnesses aren’t commonly considered terminal. This includes patient’s with end-stage renal failure, chronic obstructive pulmonary disease, and congestive heart failure.
Khullar offers one possible solution: continue separating palliative care from hospice care. He says too many doctors still associate palliative care with end-of-life care. Ideally, patient need should trigger palliative care rather than their prognosis.
We Can Help Start this Important Conversation
If you or someone you love needs to begin planning for an end-of-life transition, Southland Hospice can help. Our hospice care teams are built to ensure your physical, spiritual, and mental needs are cared for in your final days and most importantly, that your wishes are carried out. If you’d like more information you can call us at (602)-497-4100 or you can send us an email.
These aren’t the conversations you look forward to or enjoy. In fact, they could be some of the most difficult ones you ever undertake. But when they’re handled correctly, these conversations will matter most during one of the most important moments of your life.