Dr Toby Campbell Outlines the Importance of Early End-of-Life Care Discussions

The move to value-based care has increased the use of palliative care, and new research has found that conversations about end-of-life care should be happening earlier, said Toby C. Campbell, MD, MSCI, of the University of Wisconsin Carbone Cancer Center.

Transcript

Have you seen that with the growth of more value-based care models that use of hospice and palliative care has increased?

The use of palliative care and hospice has certainly increased over the last 10 years. The shift toward value-based care models, given that the fundamental principle behind palliative care is really about quality and value at the patient and caregiver level, so value-based care models really see that as an important aspect.

And so, yes, we have seen increases in palliative care programs. And I think some of that is absolutely due to payment models.

When should end-of-life care discussions take place with patients diagnosed with cancer? Are they happening at the right time?

End-of-life care discussions should happen with patients well before you’re at that point. I think, just imagine, that you’re an oncologist, and you’re working with a patient—maybe you’re working with them for months or a few years—and you have a discussion about, “Hey, you’ve got this cancer, and here’s a treatment.” And then, “Oh, there’s bad news, but I have another treatment.” At some point, you run out of treatment options. And then you face a discussion about talking about end-of-life care. Well, that’s an awfully big discussion, and it’s a really impactful one and a momentous one.

So, I think that the strategy that makes the most sense is to walk yourself back to the beginning. when you identify that a patient has a disease, which cannot be cured. So, at those early moments, before you even face any crucible moments, you start to introduce it. And then you introduce it again at any time of progression. And that way when you reach that point, where you do not have any additional treatment options that make sense, it’s a much simpler conversation. The patient is likely already aware, but it might sound something like, “You know how we’ve been talking over time that at some point we were going to reach a place where I didn’t have any additional treatment options. You know, we’re there.”

And odds are that conversation, if you imagine the one that you might have had to have without having any preparation versus that, it really alters the arc of the whole thing. But it starts—the inflection point can be modest, can mild, months or years earlier, as opposed to a giant inflection point if you wait until the end.

So, you know I don’t think that oncologists have this conversation as often as they could. We certainly have some data that suggest patients have a poor understanding of whether or not their disease is curable. And so, it certainly suggests that we could be doing this earlier.