Friday, February 20, 2009

The State of the Palliative Care Consult

Nothing has changed in 50 years

John Carney
February 20, 2009

An article and a letter to the editor in the February issue of Journal of Palliative Medicine both reflect the state of the palliative care consult. The verdict? Not good.

What I find troubling is that for far too many, goals of care rarely get talked about prior to the palliative care consult. Patients are often left to their own devices. Providers only narrowly discuss the disease for which they feel qualified and hardly any patient gets good information about the state of their advanced progressive chronic diseases. And, excuse me, but who among us is going to ask unless quality of life is hovering around zero?

We owe it to those with advanced chronic disease to be more honest and not rely on palliative care consults for the “truth dumping” that Nick Christakis reminds us can be just as deplorable.

What’s so hard about talking with folks - even theoretically - in early stages of chronic disease that it’s likely someday you’ll die from this condition? At the age of 80 or so my grandmother died after almost a half century of complications from diabetes. My father in law, at 91, died a similar death two years ago.

Little has changed with the advanced treatment of that disease in 50 years. His doctors refused to discuss palliative care alternatives with us.

At 55, I already know the chronic disease that will likely someday take my life. I just hope along the way, as it advances, I have the guts to ask where I am. Because everything tells me that neither my specialist nor my primary care doc will ever broach the subject.


The Clinical Quagmire of Palliative Consultation, Paul Russo, MD, Journal of Palliative Medicine, February 2009

Ensuring Informed End-of-Life Decisions, Kathryn Tucker, JD, Journal of Palliative Medicine, February 2009


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