Hepatologists have a responsibility to provide palliative care to their patients, and the barriers that exist to providing that care are not insurmountable, according to speakers during the Emerging Trends program at The Liver Meeting®.
“Palliative care is certainly about providing a good death, and that’s a very important core concept of palliative care, of avoiding distress and suffering in the final days of life. But it’s much more than that,” said Puneeta Tandon, MD, Associate Professor at the University of Alberta.
She noted that the World Health Organization definition of palliative care extends beyond the end days of life to the beginning stage of chronic disease.
“And, importantly it extends beyond just the patient to the caregivers and families recognizing that they also suffer as patients suffer,” she said.
Studies show that introducing palliative care in the clinic in the form of advance care planning and goals of care documentation, symptom control and management, and assessing the needs of the patient and caregiver not only reduces anxiety and mortality, but also improves symptom management and quality of life.
“Our patients suffer,” said Dr. Tandon. “Our patients suffer a lot, even more than other end organ failures. We know from a range of studies that early palliative care improves outcomes for patients. We are all trying to save costs and reduce unnecessary admissions to ICU and invasive procedures, and early palliative care does this as well.”
However, a number of barriers exist that prevent or discourage hepatologists from integrating palliative care models in the clinic, and Dr. Tandon emphasized that hepatologists must work to overcome those barriers so that patients, caregivers and health care providers can all be supported throughout the cirrhosis journey.
Few hepatologists are trained in palliative care, she noted, but workshops like the Emerging Trends session offered at The Liver Meeting® provide opportunity to develop skills and dispel myths.
“This idea of either doing curative intent or palliative intent is an old concept now and you need to get used to the understanding that palliative care and curative care work together and indeed that we have to provide our patients with symptom management right from day one, disease modifying therapy and palliative principles occurring together,” said Dr. Tandon.
She also cited several studies that show that patient anxiety is reduced by conversations with their trusted healthcare providers about their disease and prognosis.
“Patients understand that we don’t know exactly what their prognosis is going to be,” said Dr. Tandon.
“Obviously it makes sense that we should be doing this. So why aren’t we doing this? We tend to have a discomfort and even a lack of understanding of what palliative care means. And that term palliative care is sometimes difficult for us to use with patients. We don’t know how to fit it into our very busy clinical practice.”
Dr. Tandon noted that in her practice, setting a separate appointment to talk about advance care planning and providing patients and their families with resources can aid the discussion, as well as working with palliative care specialists.
“I would appeal though that we all do have a role in this. It’s something that our patients really need and we need to work together with our palliative care specialists as specialists and primary care colleagues,” said Dr. Tandon.