A Spectrum of Palliative Care

By Scott Wakeham

As our society’s aging population and burden of chronic disease is increasing, palliative care is becoming ever more necessary. The World Health Organization describes palliative care as “an approach that improves quality of life of patients and their families facing the problems associated with life threatening illness”. (1) This is not limited to end of life care and involves the family, recognizing the health disparities that affect these ‘secondary patients’.

Palliative care extends beyond the spectrum of end of life care. Many clinicians and patients are hesitant to use palliative care services due to the belief that its intent is to hasten death. (2) Unfortunately, this belief may delay care that improves quality of life,  serves to affirm life, and regards dying as a normal process. Early palliative care has many benefits in providing patients and families with comfortable care. In stem cell transplantation, addition of a palliative care consultation resulted in less decreased quality of life for patients which persisted for up to three months. (3) A randomized control trial also showed that involvement of palliative care at time of diagnosis of non-small cell lung cancer led to anincreased life expectancy of 2.7 months, improved quality of life, mood, and less aggressive interventions at the end of life (4)

Beyond the care provided by health care professionals, it is also necessary to mention those providing an estimated 55% of care to palliative oncology patients: the informal caregiver. (5) Notably, informal caregivers may experience financial strain, emotional and psychological difficulties, social dysfunction, and feelings of helplessness. (6) Providing care to a loved one has been researched to provide the caregiver with better self-acceptance, personal growth, satisfaction, and a sense of accomplishment. (6) Utilizing informal caregivers also has an economic impact; with informal care in the US being valued at $196 billion versus home health care and nursing home care costing $32 and $83 billion respectively. (7) These benefits to the patient, caregiver, and health system make a case to ensure their function and ability to continue caring for their loved ones within our healthcare system. Measuring caregiver burden and developing interventions for caregivers is a growing area of thought and research within palliative care.

Palliative care is an expanding and exciting field that provides patient centered care to improve function and quality of life throughout disease. Although year of added competency programs in palliative medicine have existed for almost 20 years in Canada, the Canadian Society of Palliative Care Physicians has been successful in lobbying for the creation of an Adult Palliative Medicine subspecialty-training program. (8) This program allows entry from Internal Medicine, Neurology, and Anaesthesiology. (9) A Royal College subspecialty for paediatric palliative medicine has also been developed with entry from paediatrics. (10)

 

  1. Definition of Palliative Care [Internet]. World Health Organization. 2017 [cited 10 March 2017]. Available from: http://www.who.int/cancer/palliative/definition/en/
  2. Volicer L Simard J. Palliative care and quality of life for people with dementia: medical and psychosocial interventions. International Psychogeriatrics. 2015;27(10):1623-1634.
  3. El-Jawahri A, LeBlanc T, VanDusen H, Traeger L, Greer J, Pirl W et al. Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation. JAMA. 2016;316(20):2094.
  4. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742
  5. Jansma FFI, Schure LM, de Jong BM. Support requirements for caregivers of patients with palliative cancer. Patient Educ Couns Aug 2005;58(2):182-186.
  6. Kang J, Shin DW, Choi JE, Sanjo M, Yoon SJ, Kim HK, et al. Factors associated with positive consequences of serving as a family caregiver for a terminal cancer patient. Psychooncology Mar 2013;22(3):564-571.
  7. Deeken JF, Taylor KL, Mangan P, Yabroff KR, Ingham JM. Care for the caregivers: a review of self-report instruments developed to measure the burden, needs, and quality of life of informal caregivers. J Pain Symptom Manage 2003 10;26(4):922-953.
  8. Vision, mission and goals for palliative care in Canada [Internet]. Canadian Society of Palliative Care Physicians. 2017 [cited 10 March 2017]. Available from: http://www.cspcp.ca/about/vision-mission-goals/
  9. Subspecialty Training Requirements In Adult Palliative Medicine [Internet]. Royalcollege.ca. 2017 [cited 10 March 2017]. Available from: http://www.royalcollege.ca/cs/groups/public/documents/document/ltaw/mtmz/~edisp/rcp-00133421.html
  10. Subspecialty Training Requirements In Pediatric Palliative Medicine [Internet]. Royalcollege.ca. 2017 [cited 10 March 2017]. Available from: http://www.royalcollege.ca/cs/groups/public/documents/document/ltaw/mtmz/~edisp/rcp-00133423.html

 

 

 

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