November 17, 2015
First, thank you for penning an article on palliative care as an alternative to invasive and costly medical care. I would like to respond and expand on a few points made in the article, as palliative care is one of my areas of research.
Financial: You make the point that care is expensive in the last 5 years of life. This is true, and you aptly point out that Medicare spends one-fourth of its dollars on patient care at the end-of-life. This is a significant burden to both the finances of the patient and their families as well as the healthcare system.
End-of-life care: I agree and research has shown that palliative care is a vital alternative to aggressive care at the end-of-life, especially in the geriatric population you reference.
Now, I would like to clarify a few things regarding palliative care. The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, sychococial, and spiritual.”
A common misunderstanding of palliative care is that it is for end-of-life patients only. This is where hospice is appropriate, yet in this country we misunderstand hospice and palliative care to mean the same thing. This leads to underutilization of palliative care as patients and families think it means they’re giving up. On the contrary, early access to palliative care is essential at any point in a disease trajectory, should be discussed at diagnosis, and is appropriate across the lifespan, from birth to old age. The use of palliative care does not preclude curative therapies either, and both can be received simultaneously.
Our population of older Americans is growing, and our advances in healthcare are extending life, especially life with chronic illness, beyond what was previously possible. Palliative care plays a vital role in managing the consequences and complications of chronic and/or life-threatening illness, and while it is cost-saving, the essential of palliative care is that it respects the wishes of the patient and their choices in care. This is important as the majority of people have stated in the course of research that they prefer to die at home, and not in a “cold, unfriendly hospital room.”
Thank you for your time,
Nicholas Zumwalt, MS,
NR, CEN, CPEN
Clinical Assistant Professor
Oxley College of Health
The University of Tulsa
Editor’s Note: This letter to the editor has only been edited for clarity.