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Letter: Palliative care: Increased quality of life and decreased cost

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As a registered nurse working in a rural community, I struggle as I care for patients coming in and out of the hospital battling recurrent symptoms from chronic illnesses.

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Despite the health care team’s best attempts at relieving symptoms and providing patient education, the patients return within months for continued management. The Centers for Disease Control and Prevention estimate that approximately 90 million Americans are living with a serious illness, and this number has been predicted to double over the next 25 years. Health care costs are at an all-time high, with chronic diseases accounting for three out of every four dollars spent. How are these serious illnesses being treated? Much like the revolving door approach mentioned above.

All too often in the American health system, we treat now and ask questions later. Crazy thought: What if we asked these individuals how and where they would like their care and educated them and their family on all of the options available to them? What if we follow them after they are discharged to ensure their questions are answered and that they fully understand the course of their illness? Palliative care is the answer.

Palliative care is specialized medical care that focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness – whatever the diagnosis or prognosis. Palliative care, once thought as an end-of-life intervention, should now become the standard of care for all people with serious illness. The goal is to improve quality of life for patients at any stage of illness regardless of current treatment plans, and it is tailored to both patient and family needs. Above and beyond symptom control, the Center to Advance Palliative Care notes that palliative care also provides a patient and their family with continual close communication, assistance in navigating the health care system, guidance with difficult and complex treatment choices, and emotional and spiritual support.

Palliative care services may not be revenue-generating, but they do save the health care system money, also known as cost avoidance. A recent study found that palliative care patients had “significantly fewer emergency department visits, hospital days, skilled nursing facility days, physician visits, and a 45 percent decrease in cost related to usual care patients.” In addition to cost savings, patients whose symptoms are controlled report having a better quality of life and being more satisfied with their care. Patient satisfaction has become very important regarding the Centers for Medicare and Medicaid Services reimbursement program.

Palliative services need not be limited to patients in the hospital. There should be equal access to palliative care across health care settings, such as in the home setting, with hospice, and in long-term care facilities.

Unfortunately, palliative care resources are limited. Policy initiatives are underway to increase availability of palliative care for all patients and families facing serious illnesses.

The National Palliative Care Research Center released a “State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals” in 2011. At that time, it was reported that there was approximately one cardiologist for every 71 persons experiencing a heart attack and one oncologist for every 141 newly diagnosed cancer patients. Incidentally, there was only one palliative medicine physician for every 1,200 persons living with a serious or life-threatening illness.

In addition to workforce shortages, access to palliative care is another challenge. The American Hospital Association estimated that there are only about 1,568 hospitals out of a total of 2,489 nationwide that offer some type of palliative care program. Outpatient and home-delivered palliative care programs are even harder to come-by.

Could you or a family member benefit from symptom management, pain control or any aggravation that a chronic illness has caused you? Online, you can go to the Palliative Care Directory of Hospitals at getpalliativecare.org to learn more about palliative care and to find a hospital near you. If you are already in the hospital, ask your doctor to refer you to the palliative care team. If your hospital does not have a palliative care team, The Center to Advance Palliative Care recommends to “write to your hospital CEO and your state and federal representatives and ask them to ensure that palliative care becomes a core component of your hospital’s services.”

Palliative care provides effective and efficient, quality care at a reduced cost. With palliative care services, the patient’s and family’s needs always come first. In a patient-centered health care delivery system, I urge you to make your needs known. The more palliative care is discussed and requested by patients, the more available it will become.

Karissa Schultz, RN, BSN, Grandin, N.D.

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