American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Learning How to Die - Hospice & Palliative Care


If you’re diagnosed with a fatal, incurable disease, does that mean that you’re dying? In today’s medicine, the answer isn’t clear. Not to patients; and not to doctors. On today’s show, we’ll speak with Dr. Diane Meier, an expert in palliative and hospice care, who thinks there’s a better way to treat the nation’s sickest patients. And later in the show, a nurse practitioner who specializes in palliative care talks about her work.

Listen to the show.

Segment 1: You Don't Know What Palliative Care Is? Don't Worry, You're Not Alone (Doctors Aren't Sure Either)
Guest: Dr. Diane Meier, Director of The Center to Advance Palliative Care

Few people, asked to imagine their final weeks of life, would choose to picture themselves in and out of consciousness; with machines keeping their heart beating and their lungs breathing; unable to communicate with family and friends. But when patients and families are faced with a terminal diagnosis, it's hard to accept that there's nothing that can be done; that a cure isn't possible. Doctors are just as likely to remain hopeful - even when the treatment options they can offer have little chance of success and add little if any time to the patient's life. 

An alternative to the "try everything" approach to terminal illness exists - and results from a recent study seem to prove that it can be just as successful at extending a patient's life as medical options. Called "palliative" care, it focuses on the debilitating side effects of disease and disease treatment - side effects like pain, nausea, swelling, and shortness of breath. And unlike hospice care, which is for patients in their last weeks or months of life, palliative care isn't necessarily an alternative to surgical or drug therapy, but can accompany curative treatment.

But like many things related to serious illness and end-of-life care, conversations about palliative care are often put off until they can't be ignored. Further complicating the issue: palliative care isn't a part of most med school curriculums - many doctors don't understand it, and some are even threatened by it.

But some high-profile news items have recently brought attention to the way we deal with disease and death in this country, giving palliative and hospice care a rare spotlight. The first was a lengthy article by The New Yorker's health contributor Atul Gawande, who reported on the dilemma faced by many patients and patients' families - and their doctors - when it comes to dealing with terminal illness.  More recently, The New England Journal of Medicine published a study showing that patients who began receiving palliative care immediately upon diagnosis - in this case, lung cancer patients - lived an average of three months longer than those who chose oncology treatment alone. (In the randomized study, patients assigned to receive palliative care also spent their last days happier, more mobile, and in less pain than their peers.)

Segment 2: Conversations with the Dying
Guest: Pamela Stitzlein Davies, Palliative and Support Care Nurse Practitioner at Seattle Cancer Care Alliance

Patients diagnosed with a life-threatening or terminal illness are asked to quickly adapt to a whole new life. Even the best physicians are limited in the guidance they can offer when it comes to navigating the physical and psychological side effects of disease and disease treatment. Pain, anxiety, and depression are common. Palliative care specialists are brought it to help close the gap.