Understanding the Effects of Palliative Care on Patient Functioning

March 2014
By HCFO Staff

Patients suffering from chronic medical conditions and chronic pain are increasingly turning to palliative care as a way to relieve their symptoms and manage their care. Palliative care is an area of health care that focuses on relieving and preventing the suffering of patients. Palliative care focuses on treating symptoms and is not designed to cure disease.  In a recent New York Times article, columnist Jane E. Brody explains the benefits of using palliative care to treat chronic pain and the challenges that our medical system faces in making this type of care more widely utilized.

In her article, Brody explains that the majority of patients who should be treated with palliative care are not dying.  They are instead patients facing any health condition affecting their quality of life and ability to function.  Brody argues that the benefits of palliative care outweigh the costs of making this service widely available in hospitals, nursing homes, clinics, assisted living facilities, and patients’ homes.  Studies have shown that the benefits include fewer trips to the emergency room, fewer hospital visits, lower medical costs, and improved quality of life. Some studies have also indicated that palliative care can increase the lifespan of patients who are terminally ill.

Two major hurdles are preventing palliative care from being more widely utilized.  The first is a misperception by both patients and providers that palliative care is the same as hospice care.  Palliative care can be used to treat patients who are not suffering from terminal conditions and patients who are not yet ready for hospice care.  The second hurdle is that there is a shortage of doctors trained in palliative care.  Most doctors believe that palliative care should be used only when a patient is ready for hospice, but palliative care is not limited to medical interventions; it is most effective for improving a patient’s quality of life.

In a HCFO-funded study, Donald Taylor, Ph.D., Duke University, and colleagues investigated whether the increased use of palliative care soon after a patient’s referral improved patient functioning, an aspect of quality of life. Taylor and his colleagues hypothesized that increased use of palliative care would have a positive effect. They used data from the Carolinas Palliative Care Database Consortium to measure patient functioning. Study results showed a positive correlation between palliative care and improved patient functioning; however, the strongest predictor of patient functioning was the patient’s initial status. This was consistent with whether the patient started out with a very high or very low level of initial functioning. Their study was not able to account for patient-level variation. Still, the study reaffirms the benefits of using palliative care even when a patient is not terminally ill. The researchers suggest that future research should link the cost of care to the quality in order to conduct a complete assessment of the value of palliative care.

Taylor’s full article can be accessed here (subscription required).