Issues in Palliative Care

Bruce Feinberg, DO; Brian Kiss, MD; and Michael Kolodziej, MD, discuss challenges and opportunities for better utilizing palliative care to reduce cost and improve quality of care in oncology.

Dr Feinberg notes that currently, only half of appropriate patients receive hospice care, and the average length of stay is 7 days. Dr Feinberg asks Drs Kiss and Kolodziej to discuss ways to improve the utilization of palliative care.

Current guidelines suggest that doctors initiate discussions about palliative care with patients and patients’ loved ones when cancer has advanced or patients begin to have intractable pain, Dr Kiss explains. For this reason, palliative care is often not discussed until late in a patient’s disease course. Dr Kiss suggests that initiating conversations about palliative care early-on is key.

Dr Kolodziej describes the importance of adequate education and training in palliative care in oncology. He explains that discussing palliative care or end-of-life care with patients is among the most difficult of tasks for an oncologist. He notes that historically, there hasn’t been enough focus on educating and training oncologists regarding palliative care.

Another challenge, the result of a lack of palliative care training, is that many terms related to palliative care are misunderstood, adds Dr Kolodziej. Oncologists, he says, need to understand how to differentiate between palliative care, end-of-life care, and hospice care.