One would think it’s crazy not to have hospitals, cancer centres, or universities without emergency medicine, oncology medicine and critical care medicine specialties, but for palliative care, getting recognized as a specialty and accepted by organized medicine was way tougher. This was because it started in community hospices and palliative care teams instead of big academic centers. Plus, it focused on caring for the person rather than the usual biomedical stuff.
For a long time, medical leaders hesitated to believe that palliative care experts could improve the care given by cancer doctors and general physicians. We now have many carefully designed studies showing that palliative care specialists backed by teams from different fields, make things better for patients and their caregivers.
They enhance various health outcomes, boost end-of-life care quality, save money, and either don’t affect or even increase how long patients live. Because of these findings major science groups now say all patients with advanced cancer should have access to palliative care.
People now ask, “how can we make palliative care a reality?” instead of “do we need palliative care?” JAMA has released two studies that contribute to our understanding of how to implement palliative care. To ensure safe stepped care, we need to measure patient symptoms across the board. For research, cancer-specific tools like FACT-L for lung cancer work well.
But in practice, since palliative care deals with personal needs simple tools that apply to all cancers might work better. The Edmonton Symptom Assessment Scale (ESAS) is one such tool. It is free and takes seconds to complete. Canada’s success in using ESAS in every patient interaction looks promising.
Temel and colleagues ran a randomized controlled trial involving 510 patients. They enrolled these patients within 12 weeks of receiving an advanced lung cancer diagnosis. The study split patients into two groups. One group got standard palliative care with check-ups every 4 weeks. The other group received stepped care.
This meant they had follow-up visits when their treatment changed, or they went to the hospital. If a patient’s quality of life dropped by over 10 points on the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale, the stepped care ramped up to check-ups every 4 weeks and during hospital stays.
The platforms and electronic health records need to get better to make a few things happen. First, they should let all caregivers chosen by patients get an invite to the video visit. Second, they should make the check-in process simpler., they should get rid of the need to ask for consent again and again in each meeting with a patient.
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