Despite fundamental misunderstandings about its practice and goals, palliative care is expanding across the nation at a rapid pace. Practitioners say that's because society and the healthcare industry traditionally overlook--or want to ignore--the most difficult stages of life.
"There's definitely a gap in understanding the end of life, both from a physician's perspective and in our community--our patients, our families," says Tarek Mahdi, MD, director of Parkview Community Hospital's Palliative Care Unit and a family practitioner in Riverside.
That blind spot makes it difficult for society in general, and the healthcare field in particular, to deal with matters associated with chronic disease and death that shouldn't be ignored. "The hospitals, especially, are having a hard time transitioning from the acute setting," Dr. Mahdi says.
But acute care doesn't work for many patients. "Hospitals are admitting patients in their 80s who have pneumonia, or patients who have end-stage emphysema are being admitted again and again and again," Dr. Mahdi says. "We're dealing with a lot of chronic illness, for which there really is no cure, and palliation is the key. It's about improving their quality of life, improving their functionality, making it possible for them to live independently for as long as possible."
Most people who need palliative care have heart disease, lung disease, cancer, HIV or neurological disorders, such as Alzheimer's or Parkinson's disease. And palliative care deals directly with the difficulties associated with these conditions using a highly interdisciplinary approach. "Along with treating [a patient's] pneumonia, which I think is important, more important is integrating social services and physical therapy, and trying to rehab the patient so that after three or four days of sitting in the hospital, he can hopefully go home in a better state or in the same state as when he came in," Dr. Mahdi says.
After gradually gaining ground in the healthcare field during the past two decades or so, palliative medicine took a major step toward broad recognition in October 2006, when the American Board of Medical Specialties recognized it as a subspecialty and scheduled the first palliative-medicine board exam for October 2008. Advocates for palliative care argue that it deals head-on with topics that nearly everyone tends to avoid. The field aims to improve care and restore patient dignity by gently forcing patients who probably will not get better, as well as their families, to deal honestly with healthcare options. But these things change slowly, and palliative care is still beset with difficulties that hinder its progress.
Understanding the Field
"One of the biggest barriers to the field is that people still have this misconception that palliative care is the same thing as end-of-life care--and it's not," says Sean Morrison, MD, director of the National Palliative Care Research Center and vice chair for research at the Mount Sinai School of Medicine Brookdale Department of Geriatrics and Adult Development in New York. "You shouldn't have to be at the end of life to benefit from or receive palliative care."
Palliative medicine's professional and advocacy organizations in the United States define the field as an interdisciplinary specialty focused on improving the quality of life for seriously ill people and their families through interventions, such as managing pain and other symptoms, including emotional, psychological and spiritual distress. "What differentiates it from end-of-life care--what came before--is that palliative care can be applied and should be applied at the same time as all other appropriate therapies," Dr. Morrison says.
Palliative care's focus on comfort over cure, the physical, emotional and spiritual, has spawned perhaps the most interdisciplinary of all hospital specialist teams. Such teams generally consist of a physician, a nurse or nurse practitioner, a social worker and a chaplain, Dr. Morrison says.
