Palliative care is defined as a specialized, interdisciplinary medical care for people with serious illnesses, their families, and caregivers.1-4 Palliative care can be provided regardless of the diagnosis or the age of the patient and at any stage in a serious illness.1-3 Patients do not have to stop their treatment to receive palliative care. It can be provided simultaneously with curative or disease-modifying treatments and may begin early in the course of a serious illness.
Although palliative care is among the fastest growing fields in healthcare, only 8% of 800 adults reported knowing about palliative care in a 2011 public opinion research poll.3 A 2018 survey using the Palliative Care Knowledge Scale (PaCKS) with 301 laypersons found that it was least likely for the item “palliative care is exclusively for people who are in the last six months of life” to be answered correctly as false, of the 13 true/false questions.5 In a 2009 poll, a similar lack of knowledge was found in 12 oncology nurses about the range of services provided by palliative care compared to hospice care.6 This misinformation and confusion with hospice care can pose barriers to accessing palliative care. When informed, an overwhelming majority of consumer respondents agreed that education on and access to palliative care would be very important for patients with serious illness.3
A 2017 Cochrane review compared early palliative care interventions to usual or standard cancer care on depression, symptom intensity, quality of life, and survival in advanced adult cancer patients.7 Although effects on survival and depression were unclear, the review concluded that early integration of palliative care improve quality of life and symptom intensity. Multiple studies showed that early integration of palliative care in the illness trajectory can improve quality of care and clinical outcomes, as well as potentially prolong survival.8-10 A 2009 randomized controlled trial with 322 advanced cancer patients studied the effect of a four-week multicomponent, psychoeducational palliative care intervention.8 Although no differences were seen in physical symptom intensity measured by the Edmonton Symptom Assessment Scale, days in the hospital or ICU, or visits to the emergency department, those who received the palliative care intervention concurrently with oncology care showed improved quality of life and mood when compared to patients who only received usual oncology care. In addition, early initiation of palliative care can also improve health outcomes for family caregivers of patients with advanced cancer.9 A randomized controlled trial enrolled 122 caregivers to receive palliative care either immediately after enrollment (n=61) or three months after (n=61). In the terminal decline analysis, the study found that caregivers receiving early palliative care showed lower depression score and stress burden at three-month follow-up.
References
- National Consensus Project for Quality Palliative Care. Clinical practice guidelines for quality palliative care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. https://www.nationalcoalitionhpc.org/ncp.
- IOM (Institute of Medicine). 2014. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
- Elizabeth, H, McInturff, B. 2011 Public opinion research on palliative care. Center to Advance Palliative Care (CAPC) with support from the American Cancer Society (ACS) and the American Cancer Society Cancer Action Network (ACS CAN). 2011. https://media.capc.org/filer_public/18/ab/18ab708c-f835-4380-921d-fbf729702e36/2011-public-opinion-research-on-palliative-care.pdf. Accessed Dec 26, 2018. .
- World Health Organization. 2018. WHO definition of palliative care. https://www.who.int/cancer/palliative/definition/en/. Accessed Dec 26, 2018.
- Kozlov E, McDarby M, Reid MC, Carpenter BD. Knowledge of palliative care among community-dwelling adults. Am J Hosp Palliat Care. 2018;35(4):647-651.
- Mahon MM, McAuley WJ. Oncology nurses' personal understandings about palliative care. Oncol Nurs Forum. 2010;37(3):E141-150.
- Haun MW, Estel S, Rücker G, Friederich HC, Villalobos M, Thomas M, Hartmann M. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017, Issue 6. Art. No.: CD011129. DOI: 10.1002/14651858.CD011129.pub2.
- Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302(7):741-749.
- Dionne-Odom JN, Azuero A, Lyons KD, et al. Benefits of Early Versus Delayed Palliative Care to Informal Family Caregivers of Patients With Advanced Cancer: Outcomes From the ENABLE III Randomized Controlled Trial. J Clin Oncol. 2015;33(13):1446-1452.
- Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
