Palliative Care Quote Book: Moving Palliative Care Upstream

As the palliative care movement continues to build momentum forward and into new territories, the question that continues to follow “How do we deliver the best care possible to patients with serious illness?” is “When should we do it?” Specialists are telling us that the answer to the “When?” has never been more clear: as soon as possible in a patient’s illness trajectory.

Research supports this claim as well.

Just using cancer as an example, the results of recent research conducted at the University of Alabama-Birmingham School of Nursing show that early initiation of palliative care for patients with advanced cancer may not only improve their survival, but also reduce the depression and stress burden of family caregivers. The analyses, which focused on patient outcomes as well as benefits for informal family caregivers, compared early initiation of palliative care with initiation that was delayed for 3 months. In the patient study, results showed that 1-year survival rates were 63% in the early palliative care group and 48% in the delayed-care group. In the caregiver study, which focused on issues of stress and depression, the early initiation group also showed improved outcomes.

“These data support the importance of providing this care at the same time as medical treatments aimed at fully curing disease. Too often, that is not the case,” said Marie A. Bakitas DNSc, CRNP, the Marie L. O’Koren endowed chair and professor at the Birmingham School of Nursing.

Last year, a study released by Duke University Hospital showed that cancer patients who receive palliative care earlier are readmitted to the hospital less than those who do not take advantage of this medical specialty. The Duke researchers used a collaborative model in cancer care—a partnership between medical oncologists and palliative care specialists—to deliver cancer care for patients admitted to the hospital’s solid tumor unit. This model, which included multiple meetings a day between specialists, aimed to cultivate collaboration and communication to achieve the highest quality patient care. This model proved effective, showing a 23-percent decrease in the number of patients readmitted to the hospital with a week of discharge. Results also showed that patients were discharged from the hospital sooner and transfers to the intensive care unit decreased.

“The findings emphasize the value of implementing palliative medicine soon after a cancer diagnosis rather than waiting until later in the disease’s progression. The new approach allows patients earlier opportunities to discuss their care goals and quality of life, which is becoming a central issue among health policy leaders,” says the Duke University Medical Center.

To add voices to what the data show, we asked two palliative care specialists to give us their reasoning for why upstream palliative care is beneficial to the patient, clinician and institution at large. They both say it comes down to better communication.

Emily Riegel MD, Assistant Professor of Palliative Care at the University of Kansas Medical Center knows firsthand the benefits of implementing palliative care early in the disease process. Her program’s journey into the outpatient setting has given them an opportunity to meet patients earlier and in their own environments.

In this next video, Dr. Rab Razzak, Director of Outpatient Palliative Medicine at Johns Hopkins Medicine, talks about how implementing palliative care at diagnosis has allowed him to build lasting relationships with patients throughout their disease process.


Would you like to share your thoughts or findings on upstream palliative care? Post a comment below or email Dan.Altano@mssm.edu to have your voice heard!

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