baby-boomers age and the number of people with serious chronic illnesses
continues to rise, the demand for experts in palliative medicine is sure to
outstrip the supply, according Timothy E Quill, MD, professor of Medicine,
Psychiatry and Medical Humanities in the Center for Ethics, Humanities and
Palliative Care at the University of Rochester Medical Center.
perspective published in New England Journal of Medicine, Quill,
who serves as president of the American Academy of Hospice and Palliative
Medicine (AAHPM), suggests that arming generalists and other specialists with
primary palliative care skills is a practical, cost-effective and sustainable
way to expand the delivery of palliative care.
Born out of
a hospice tradition, palliative care offers relief of pain and symptoms and
assistance with medical decision-making to anyone with a serious illness,
regardless of prognosis.
Lessen pain and provide family support
The goal is
to alleviate patient suffering through high-quality pain and symptom management
and to provide added support for patients and their families – all while
patients are receiving effective medical treatment of their underlying disease.
that with appropriate education and training, many fundamental aspects of
palliative care can be provided by those already caring for a patient.
avoid adding another team of caregivers to a patient's care or setting the
expectation that certain palliative care tasks – such as basic symptom
management and psychosocial support – are only the role of a palliative care
"In a coordinated
palliative care model, the primary care physician or treating specialist could
manage many palliative care problems, initiating a palliative care consultation
for more complex situations," Quill said.
Increased access to care
this occurs, the patient may eventually return to the referring specialist or
the primary care physician for ongoing palliative care management when that is
deemed desirable by everyone involved. This model allows increased access to
specialty palliative care consultation and reinforces delivery of primary
palliative care by everyone caring for seriously ill patients."
has been increasing emphasis on including palliative care as a fundamental part
of the care of people with serious illness because it leads to better quality
of life, less depression, less health care waste, and maybe even longer survival,"
said Amy P Abernethy, MD, of Duke University School of Medicine, who
co-authored the perspective.
symptom control, defining and aligning goals of care, and attention to the needs
of the family are just some of the fundamental principles of palliative care to
be included in the generalist and specialist palliative care toolbox."