"Palliative care with the knife, needle, poison, & ray-gun."

As the holidays come storming towards me, I haven't been posting as much, & I expect things from my end will be lax until after the new year. Thanks to Christian for picking up the slack. I can't emphasize how interesting the Hastings Center report is, and appreciate Dr. Sinclair's posts.

I wanted to briefly highlight two journal issues which have devoted a series of articles on end of life care:

First, Journal of Clinical Oncology has published 3 pieces on pediatric death & end of life care--one about end of life preferences of kids dying of cancer; one about patient and physician impressions about what constitutes quality terminal care; and the last a survey of bereaved parents regarding stress/coping/etc. What was striking about the first article (which involved interviews with 20 kids aged 10-20 years who were dying) was how similar their end of life preferences, decision making algorithms, etc. were to what I see as adults' preferences & algorithms. Top on the list was both how their disease and decisions affected family members as well as concerns about their symptoms/suffering.

The Journal of the American Osteopathic Association has published a supplement on "Holistic care for cancer pain" (Table of contents here; there's free full-text on all of these articles). There are articles on non-pharmacologic & complementary treatments of cancer pain, pharmacologic therapies, etc., as well as the American Osteopathic Association's statement on end of life care which is very reasonable.

I was greatly disappointed however by the article "Palliative care: optimizing quality of life." With a title like that, I thought it would be a nice, soft, promotional overview of the profession and patient-care model I know as 'palliative care.' Instead, we get an a section on "palliative chemotherapy" (perpetuating the confusion between non-curative but life-prolonging chemo & truly "palliative," symptom-reducing treatments...such as they are**), palliative radiotherapy, palliative surgery, and palliative interventional therapies (celiac plexus blocks and the like). All of this is swell & all of these interventions can be wonderful, but this is a very different conception of palliative care that I, & I suspect most of us, see daily--which involves help with end of life decision making, advanced care planning, grief/bereavement/spiritual support for patient and family, & a whole bunch of medical therapies for pain & symptom management. All of these, I hope, are part of "optimizing" quality of life.

I'll stop my tirade now. Maybe I'm just thrown by the title, which should instead be something like "Palliative care with the knife, needle, poison, & ray-gun."

**See here & here.

Posted by Drew Rosielle MD on Friday, December 23, 2005

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