Expanding Comfort Care

Palliative care can be provided by generalists and treating specialists

(RxWiki News) There are a number of facets to living with serious illness such as cancer. In addition to treating the cancer, a patient often needs pain relief and management of other symptoms. Who provides this care?

According to experts in the field, palliative – or comfort care – can be provided by general practice physicians and treating specialists.

Palliative care specialists aren’t necessary to provide basic care for patients and support for their caregivers.

"Ask for whatever care you need to feel your best."

Palliative care has its roots in hospice care. However, instead of being administered only at the end of life, palliative care seeks to relieve suffering at any stage of illness.

This care provides symptom management support for the patient and support for the patient’s caregivers.

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, offered his expert perspective in a recently published article.

Dr. Quill and co-author, Amy P. Abernethy, MD, of Duke University School of Medicine, pointed out that as baby boomers continue to age, the demand for palliative care will outstrip the supply of providers. Therefore, the pool of professionals who provide this basic symptom relief care will need to be expanded.

“As in any medical discipline, some core elements of palliative care, such as aligning treatment with a patient's goals and basic symptom management, should be routine aspects of care delivered by any practitioner,” the authors wrote.

“I completely agree. Palliative care is good care in general,” Christina M. Puchalski, MD, MS, FACP, founder and director of the George Washington Institute for Spirituality and Health (GWish), told dailyRx News. “The biopsychosocial and spiritual care model should be the framework for all patient centered and compassionate health systems.”

Drs. Quill and Abernathy said that this expansion of basic care needs to start with clarifying roles, followed by education and training. 

“As part of this planned expansion of palliative care delivery, we need a care model that distinguishes primary palliative care (skills that all clinicians should have) from specialist palliative care (skills for managing more complex and difficult cases), so that they can coexist and support each other,” the authors wrote.

Such a system would simplify care and not add another layer of providers into an already complex care situation.

"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," Dr. Quill said.

"When 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," said Dr. Quill who serves as president of the American Academy of Hospice and Palliative Medicine.

This perspective was published March 4 in the New England Journal of Medicine.

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Review Date: 
March 8, 2013