Monday, January 26, 2009

HPM Issues 2009:
#4 Getting Palliative Care Into Mainstream Medicine

(This is the second in a series of 5 posts about issues in hospice & palliative medicine I think will be important in the next year. Feel free to disagree!)*

#4 Getting Palliative Care Into Mainstream Medicine
For a new field palliative care has established a lot of buzz among hospitals and more generally in medicine. But this buzz and excitement for palliative medicine has caused many to rush into the game without a lot of uniformity to palliative care. This can lead to confusion about the merits of a good palliative care program. (read this link!)

  • Is it just hospice in the hospital?
  • Is it just good medical care?
  • Do you need a palliative care physician to run a palliative care program or can you get by with a nurse and a part-time social worker?
  • Can you have a palliative care team if it is just a physician and no other disciplines?
All these questions are answered differently depending on where you practice. The faculty at CAPC is working hard towards some standardization of what defines a palliative care team and what metrics are measured. The certification of HPM physicians will also start to establish a level of competency and quality of care allowing people outside the field to get a more defined sense of palliative care.

But there is still work to do to get palliative care mainstream. I often introduce the palliative care team to patients and families as one that has been at the hospital for eight years as some evidence this is not just some new fangled idea. And yet I (and I know some of my peers) still get the consult, followed by the dreaded 'un-consult' because the doctors, patients, floor nurses, or families just are not ready for a palliative care consult. The role of palliative care is still being misunderstood even in established programs. A good palliative care team knows there are times to advocate for a PEG tube, a reversal of a DNR, or a high risk surgery with little expected benefit. Good palliative care meets the patient and family where they are.

Maybe this difficulty in defining the role of palliative care is not so much of a curse. Maybe palliative care could be defined more as a chameleon as the role of the team shifts to meet the needs of the patient and family. The same needs easily overlooked in a hurried, technology driven, curative driven modern healthcare system: comfort, communication, and psychosocial support.

The easiest way to really mainstream palliative care is to highlight when you see good palliative care outside of your team. Make all of medicine realize that palliative care is possible from everyone in health care. Then they will know palliative care when they see it.

(PS This doesn't even get to the issue of outpatient palliative care which has it's own implementation and mainstream issues)
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