Growth in palliative care a response to EOL issues

Medical community welcomes growing field

Surveys of ethics committees have long shown that the greatest share (90%) of ethics committee consults in the United States pertain to end-of-life issues. But in one growing specialty, ethics consults are about almost nothing but end of life.

Sometimes called the "everything else doctors" — meaning everything but a cure — palliative care specialists are there to support patients facing life-threatening illnesses and to provide relief from the physical and emotional suffering the patients and their families are going through. A study by Mount Sinai Medical Center in New York and the Washington, DC-based American Hospital Association (AHA) found that the number of palliative care programs grew from 632 to 1,037 between 2000 and 2003.

Some 1,200 U.S. physicians have been certified as specialists in palliative care since 1996 by the American Board of Hospice and Palliative Medicine, and the field continues to grow, according to Charlotte J. Williams, MD, assistant professor at the University of Alabama at Birmingham, which has opened three palliative care units at the university and Veteran's Health Administration (VHA) hospitals in the Birmingham area in recent years.

"Some [entering palliative care medicine] are residents who have expressed an interest in palliative care and found a mentor in our section, or had a patient experience that caused them to become interested in specializing in palliative care," says Williams.

"Others are older physicians who maybe have become disillusioned and have chosen to re-train and improve their skills in the area. Many of us have had a family end-of-life experience and it feels like a mission to improve patient care at the end of life."

Williams says the medical community is welcoming the expanding field, because access to palliative care was an ethical issue in the past.

"Withdrawing or withholding treatment, do-not-resuscitate orders, surrogate decision making — just like patients and family members— staff come in with diverse values and backgrounds, and people need to be educated about what America in general and people individually believe about end-of-life issues," she says.

An author of the Mount Sinai study writes that the growth of palliative care "is a win-win for both patients and hospitals," because palliative care provides quality care to patients in a way that is efficient and cost-effective.

The study showed that while palliative care has grown as a field nationwide, larger medical centers and VHA hospitals are more likely to have palliative care programs than smaller institutions. Hospitals that have their own hospices are more likely to have palliative care programs, as are hospitals that have American College of Surgeons oncology programs.

The AHA reports 22.2% of all U.S. hospitals have palliative care programs.

Factors influencing the growth of palliative care programs include the rising cost of caring for chronically ill Medicare patients and data showing that historically pain symptoms have been treated inadequately.