Nov. 16, 2011 -- Though doctors nearly universally agree that helping patients die without pain is a more important goal than doing everything possible to prolong their lives, many say it can be tough to talk to patients about palliative care, a new poll shows.
The poll results were released by the National Journal and The Regence Foundation, the nonprofit arm of the Regence health insurance company. The results reveal some of the struggles doctors face caring for patients who are at life's end.
Palliative care is a kind of care for people who have serious illnesses. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life not just in your body, but also in your mind and spirit. Sometimes palliative care is combined with curative treatment.
Out of 500 board-certified doctors surveyed, almost all said that when caring for terminally ill patients, it is more important to relieve pain and enhance quality of life than to use every possible medical intervention to try to prolong patients' lives.
But when that same question was posed to Americans in the general population, only 71% of them said they shared that belief.
"There is a pretty strong sense in the public and an overwhelming sense among providers that the goal should be to enhance the quality of life rather than just extending it to the last moment possible," says Ronald Brownstein, editorial director of National Journal. "But there are really significant cross pressures that play in and there are significance barriers to that kind of care being available and delivered."
One of those pressures, for example, was a belief among doctors that patients might see an attempt to bring up end-of-life care as a sign that their doctor had quit the fight for their lives.
About one in four doctors surveyed said they were reluctant to recommend palliative care for fear that patients would think they were not doing everything possible to extend their lives.
And 42% of doctors in the survey expressed concern that emphasizing palliative care couldinterfere with efforts to prolong life.
In a panel discussion that followed presentation of the poll results, experts pointed out that the two goals need not be mutually exclusive.
"Palliative care is a medical subspecialty that's appropriate for all patients with serious illness -- regardless of diagnosis or the stage of their disease -- that focuses on symptom management and pain control, but also the stress of serious illness and quality of life for patients and their families," says Amy S. Kelley, MD, assistant professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York City.
Patients' Concerns About Palliative Care
Poll results reveal that palliative care is not always accepted by patients.
Nearly 60% of doctors report that they've had patients or their family members reject their recommendations for end-of-life treatment.
Patient reactions can shape a doctor's willingness to make palliative care part of their practice.
"It doesn't take that many patients to react badly for you to have kind of an outsized impression as a doctor that this is a fraught territory, a territory with a lot of land mines in it," Brownstein says.
Paying for End-of-Life Care
Patients and doctors also appear to differ on how health care dollars should be spent at life's end.
The cost of end-of-life care in the U.S. is substantial.
Studies have shown that roughly a quarter of Medicare's budget goes to patients in the last year of their lives, a share that hasn't changed substantially in at least three decades.
Nearly 80% of doctors surveyed say too much money is spent trying to extend the lives of seriously ill patients.
But only 37% of Americans agreed with that statement in the poll, and more than half said the system has the responsibility to spend whatever it takes to prolong life.
Brownstein says people don't seem to like the idea that money should be under discussion at such a personal and profound moment.
"I really think the fault line here is to the extent any of this kind of care is seen as increasing options for patients and their families, people really welcome it," Brownstein says. "If it is seen as an agenda to save money for the government or insurance companies, they really recoil from it. And that is a really bright line in how people react."