Palliative Care . Cardinale B. Smith, MD, MSCR Assistant Professor Division of Hematology/ Medical Oncology Tisch Cancer Institute Brookdale Department of Geriatrics & Palliative Medicine Hertzberg Palliative Care Institute Icahn School of Medicine at Mount Sinai. Palliative Care.
Cardinale B. Smith, MD, MSCR
Assistant Professor Division of Hematology/ Medical Oncology Tisch Cancer Institute
Brookdale Department of Geriatrics & Palliative Medicine Hertzberg Palliative Care Institute
Icahn School of Medicine at Mount Sinai
Life Prolonging Care
Disease Modifying Therapy
curative or restorative intent
Palliative Care Is NOT
95% of respondents agree that it is important that patients with serious illness and their families be educated about palliative care.
92% of respondents say they would be likely to consider palliative care for a loved one if they had a serious illness.
92% of respondents say it is important that palliative care services be made available at all hospitals for patients with serious illness and their families.
CAPC/ACS Public Opinion Survey, 2011
Heart disease: 1:2 men; 1:3 women (age 40+)
Cancer: > 1:3
Alzheimer's: 1:2.5 – 1:5 by age 85
Lifetime Risk of:
(slide adapted from Joanne Lynn, MD, Rand Health/CMS)
1. The Clinical Imperative
The need for better quality of care for people with serious and complex illnesses.
Dartmouth Atlas of Health Care 1999 & 2006
% of 5176 patients reporting moderate to severe pain between days 8-12 of admission
Colon Cancer 60%
Liver Failure 60%
Lung Cancer 57%
Desbiens & Wu. JAGS 2000;48:S183-186.
2. Concordance with patient and family wishes
What is the impact of serious illness on patients’ families?
What do persons with serious illness say they want from our healthcare system?
the dying process
Singer et al. JAMA 1999;281(2):163-168.
Wright et al. JAMA 2008 300(14):1665-1673
Study of 475 family members 1-2 years after bereavement
Tolle et al. Oregon report card.1999 www.ohsu.edu/ethics
Apatira et al. Ann Intern Med. 2008;149(12):861-8
3. The demographic imperative
Hospitals need palliative care to effectively treat the growing number of persons with serious, advanced and complex illnesses.
US Census Bureau, CDC, 2003
Anderson GF. NEJM 2005;353:305
CBO High Cost Medicare Beneficiaries May 2005
63% of all hospitals and 85% of mid-large size hospitals report a palliative care team
100% of cancer centers report a palliative care team
4. The educational imperative
Every doctor and nurse-in-training learns in the hospital.
“Clinical instruction must include important aspects of … end of life care (average 14 hours).”
4. The fiscal imperative
Hospital and insurers of the future will have to efficiently and effectively treat serious and complex illness in order to survive.
Healthcare Spending and Quality 5 years
U.S. leads the world in per capita spending
27thin life expectancy
37thin overall quality of healthcare system (WHO)
HCFA, Office of the Actuary, National Health Statistics Group, 2003
Adjusted results, n>20,000 patients
Morrison et al. Arch Internal Med. 2008. 168 (16)
Cost savings/Day for Live Discharges
Morrison et al. Health Affairs 2011 30:454-63
U. Michigan- Hospice of Michigan Consultation Palliative Care Reduces Hospital Costs (patients with complete data as of July 1, 2002, at Medicare prices, excludes Rx)
Aug 19 2010;363(8): Consultation 733-42
For patients, palliative care is a key to:
For clinicians, palliative care is a key tool to:
help to handle repeated, intensive patient-family communications, coordination of care across
settings, comprehensive discharge planning
assists with controlling pain and distress for highly
symptomatic and complex patients, 24/7 -thus supporting clinician’s treatment plan
increases patients’ and families’ satisfaction with the quality of care provided by the clinician
For hospitals, palliative care is a key tool to:
Gelfman LP, Morrison RS. J Palliat Med, 2008
"When we honestly ask ourselves which people in our lives mean the most to us, we often find that it is those who, instead of giving advice, solutions, or cures, have chosen rather to share our pain and touch our wounds with a warm heart and tender hand. The person who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing, not curing, and face with us the reality of our powerlessness, that is a person who cares.”