Palliative Care

In Palliative Care, Comfort Is the Top Priority

by Paula Span, NY Times, February 12, 2016

This is an important article that serves as a great introduction to Palliative Care.  What follows are some quote.

Palliative care, focuses on relieving the discomfort and distress of serious illness, and it differs from hospice.  Many patients and families know little about palliative care; it only became an approved medical specialty in 2007.

Unlike hospice, palliative care patients can use it at any point in an illness — many will “graduate” as they recover — without forgoing curative treatment.  Like hospice, however, it focuses on quality of life, providing emotional and spiritual support for patients and families, along with drugs and other remedies to ease symptoms. Its practitioners help patients explore the complex medical decisions they often face, then document their preferences.

It pays off for patients and families. In 2010, a randomized trial of 151 patients with metastatic lung cancer at Massachusetts General Hospital found that those who received early palliative care scored significantly higher on quality of life measures than those receiving standard care, and were less likely to suffer from depression.  In spite of this, palliative care remains underused.

References:

1. New Frontiers in Outpatient Palliative Care for Patients With Cancer.

Rabow MW.  Cancer Control. 2015 Oct;22(4):465-74.  Free Full Text

2. Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life.  Ritchie C.  PLoS One. 2016 Feb 12;11(2):e0148096  Full Free Text.

Not Death, a System Failure

Her mother  “had four months in the I.C.U., endless and pointless and painful procedures, and final days full of fear and despair. Why is this medicine’s default death for so many people?”

See: Not Just a Death, a System Failure

By Barbara Moran NY Times February 8, 2016

On the Dreams of the Dying

by Jan Hoffman. NY Times, February 2, 2016

This is a thought-provoking article.  It’s a bit long, but worth slogging through.

A team of clinicians and researchers at Hospice Buffalo are seeking to demystify end of life dreams and understand their role and importance in supporting “a good death” — for the patient and the bereaved.  They are studying people on a journey towards death, not people who just missed it.

¶A 76-year-old patient said he dreamed of his mother, who died when he was a child. He could smell her perfume and hear her soothing voice saying, “I love you.”

“We should be opening the door with our questions, but not forcing patients through it,” Dr. Timothy Quill said. “Our job is witnessing, exploring and lessening their loneliness. If it’s benign and rich with content, let it go. But if it brings up serious old wounds, get real help — a psychologist, a chaplain — because in this area, we physicians don’t know what we’re doing. ”

“The huge challenge of this work is to help patients feel more normal and less alone during this unusual experience of dying,” he said. “The more we can articulate that people do have vivid dreams and visions, the more we can be helpful.”

Image from Times article

When I Die

An end-of-life doctor faces his own end-of-life from a glioblastoma.

When I Die.

Peter Rasmussen was always able to identify with his patients, particularly in their final moments. But he saw himself especially in a small, businesslike woman with leukemia who came to him in the spring of 2007, not long before he retired. Alice was in her late fifties and lived in a sparsely furnished farmhouse outside Salem, Oregon, where Rasmussen practiced medical oncology. Like him, she was stubborn and practical and independent. She was not the sort of patient who denied what was happening to her or who scrambled after any possibility of a cure, no matter what the cost. As Rasmussen saw it, “She had long ago thought about what was important and valuable to her, and she applied that to the fact that she now had acute leukemia.”

This is an excellent article in the January 2016 Harper's Magazine.  It was sent to us by Kathy McKnight.

Dr. Rasmussen and family members