Patients who have cancer or dementia tend to receive more end-of-life care

Palliative care is an approach to treatment that focuses on easing symptoms, such as pain, and improving quality of life for people with life-threatening illnesses, according to the U.S. National Institutes of Health. It also aims to offer support to families and loved ones of the seriously ill person.

Hospice care also offers similar assistance and support for the sick person, as well as their families. But, hospice care generally begins when attempts to cure the disease stops. Palliative care, on the other hand, can be offered in conjunction with curative care, according to the NIH.

Using medical records and results from the “Bereaved Family Survey,” the researchers reviewed data from 146 hospitals in the VA health system for patients who died between 2009 and 2012.

Among nearly 58,000 patients, half of those with kidney disease, heart failure and frailty received palliative care consultations, compared with 75 percent of cancer patients and 61 percent of dementia patients.

In addition, about one-third of those with kidney failure, heart failure and frailty died in an intensive care unit. But, just 13 percent of cancer patients and 9 percent of dementia patients died in intensive care units, the study showed.

Cancer and dementia patients were also more likely to have “Do not resuscitate (DNR)” orders, which means no extraordinary measures should be taken to prolong life, such as shocking the heart when it stops beating. Around 94 percent of those with cancer and dementia had a DNR, compared to 87 percent of those with other serious illnesses who chose to have a DNR, the study revealed.

About 60 percent of families of cancer and dementia patients rated the end-of-life care as excellent. About 54 percent of families of patients with other conditions gave a similar rating, the researchers found.

Wachterman said one limitation of the study was the difficulty of defining frailty. Another is that these findings may not apply to patients being treated outside the VA system.

Outside the VA system, patients may not get their choice of whether they get end-of-life care or not. Currently, Medicare patients have to choose whether to get palliative care or continue with curative care — they can’t have both, according to Dr. F. Amos Bailey. He is a palliative care physician at the University of Colorado School of Medicine in Aurora.

“This is called the ‘terrible choice,’ ” he said. “It’s being recognized as a false dichotomy. In fact, palliative care and curative care should be integrated.”

Bailey coauthored an editorial to accompany the study findings, which were published June 26 in JAMA Internal Medicine to coincide with presentation at AcademyHealth’s annual research meeting in Boston.

“Patients should get both,” he said. “Studies show that those who do get better care are less depressed and live longer.”

Dr. Eric Widera, an associate professor of medicine at the University of California, San Francisco, also believes end-of-life care should be offered to all patients suffering from a life-threatening condition.

“A lot of people have misconceptions about palliative care — that it’s just for people at the very end of life,” he said.

Palliative care can be for anybody who is dealing with a serious illness, he explained. And, he noted that it can benefit family members, too.

“Think about asking your doctors about getting palliative care involved earlier in the disease as an extra layer of support,” Widera suggested.

More information

For more on end of life care, visit the U.S. National Institutes of Health.

From Wiki:

Palliative care[1] is a multidisciplinary approach to specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, physical stress, and mental stress of a serious illness—whatever the diagnosis. The goal of such therapy is to improve quality of life for both the patient and the family.[2][3] Palliative care is provided by a team of physicians, nurses, and other health professionals who work together with the primary care physician and referred specialists (or, for patients who don’t have those, hospital or hospice staff) to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care or along with curative treatment. Therefore, although it is an important part of end-of-life care, it is not limited to that stage. Palliative care can be provided across multiple settings including in hospitals, in the patient’s home, as part of community palliative care programs, and in skilled nursing facilities.

Interdisciplinary palliative care teams work with patients and their families to clarify goals of care and provide symptom management, psycho-social, and spiritual support.

Physicians sometimes use the term palliative care in a sense meaning palliative therapies without curative intent, when no cure can be expected (as often happens in late-stage cancers). For example, tumor debulking can continue to reduce pain from mass effect even when it is no longer curative. A clearer usage is palliative, noncurative therapy when that is what is meant, because palliative care can be used along with curative or aggressive therapies.

Starting in 2006 in the United States, palliative medicine is now a board certified sub-speciality of internal medicine with specialised fellowships for physicians who are interested in the field.[4] Palliative care utilises a multidisciplinary approach to patient care, relying on input from pharmacists, nurses, chaplains, social workers, psychologists and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient’s life. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual and social concerns that arise with advanced illness.

Medications and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat aching related to an influenza (flu) infection.

Although the concept of palliative care is not new, most physicians have traditionally concentrated on trying to cure patients.

The focus on a person’s quality of life has increased greatly since the 1990s. In the United States today, 55% of hospitals with more than 100 beds offer a palliative-care program,[5] and nearly one-fifth of community hospitals have palliative-care programs.[6] A relatively recent development is the palliative-care team, a dedicated health care team that is entirely geared toward palliative treatment.