COMMUNITY VIEW

View: Palliative care brings comfort

Daniel Pomerantz, M.D.
Palliative care can help patients make appropriate plans for their care, keep them out of the hospital and give them greater comfort.

Imagine a pill that allows seriously ill people to live longer, better lives, spend less time in the hospital. Imagine that it even makes it more likely to die at home surrounded by family, rather than in the hospital surrounded by machines. I am that pill. I am a palliative care specialist, but I don't get to see many patients who need my help, because their doctors haven't prescribed me.

The Center To Advance Palliative Care defines palliative care as care that provides an additional layer of support for patients and families coping with serious illness. Many people don't know about palliative medicine, and many who do assume that only people who are near death need it. The confusion is understandable because palliative medicine grew out of the hospice movement, which is focused on the care of people dying of serious illnesses, like cancer. Palliative care doctors and nurses, on the other hand, focus on providing family and patient support, managing uncomfortable symptoms, not only pain, but also shortness of breath, nausea, fatigue and others. We listen to our patients' goals and values and help them make plans, so they can live with serious illness as fully as they want to.

Early referrals

Doctors, too frequently, only think about palliative care when their patients are already dying, when they are too sick to go on with other forms of treatment, and when they feel they have nothing left to offer. When doctors refer their patients to me for palliative care consultation so late, I am limited in what I can offer to them and their family. I can still help, but sometimes all I can do is give comfort to the dying patient and help the family to cope. I am always grateful for the opportunity to help; that is why I became a doctor and a palliative care specialist. But I frequently wish I could do more. I can only do more if I meet my patients when they are sick, but not yet dying.

Montefiore New Rochelle Hospital

New York State has recognized the importance of palliative care. A few years ago, the Legislature passed and the governor signed two laws – The Palliative Care Information Act and the Palliative Care Access Act – that require doctors and hospitals to provide to patients, who might benefit from it, information about palliative care. In my experience, the laws have not made a meaningful difference in how early many patients are referred to me. Patients are still not referred early enough to make a big difference in the quality of life for them and their family.

Talk now

Thursday marks the eighth annual National Healthcare Decisions Day. NHDD's mission is to inspire, educate and empower the public and providers about the importance of advance care planning. Take time to talk to your friends, your family or your doctor about your health-care values. A discussion now can help you and your family go through difficult times more easily. Dr. Atul Gawande in his book, "Being Mortal: Medicine and What Matters in the End," recommends that patients coping with serious illness, their families and their doctors understand each patient's answers to the following questions:

• What is your understanding of where you are and of your illness?

• What are your fears or worries for the future?

• What are your goals and priorities?

• What outcomes are unacceptable to you?

• What are you willing to sacrifice and not?

• What would a good day look like?

You may not have answers to all of these questions right away. You may need to talk to your doctor. You should definitely talk to your friends and family. We may not like to think about illness and death, but those who take the time to do so, generally experience less distress and dissatisfaction with their care, and better quality of life.

Help with decisions

Drug companies have been very successful in getting doctors to prescribe the medicines they make by advertising directly to patients. So please consider the following advertisement for palliative care:

If you or a loved one has a serious illness like heart disease, lung disease, cancer, or dementia, or you need help coping with pain or other symptoms – if you need help making plans about your health care, or you feel like it is too difficult to make your decisions without help, then palliative care can help. Pharmaceutical companies must also include a list of side effects, so here's what you may experience from palliative care: greater comfort, less depression and family distress, less time in the hospital, more time at home. So on National Health Care Decisions Day, ask your doctor if palliative care is right for you.

The writer is a board-certified physician in both Internal Medicine and Hospice and Palliative Medicine, and is director of Palliative Care, Montefiore New Rochelle Hospital.