Despite Barriers, a Majority of Physicians Support Palliative Care…Do You?

A poll released Tuesday showed, at 96%, overwhelming support for palliative care by the physicians in the study who believed in the enhancement of life quality for seriously ill patients over the extension of life.  The percent of physicians that think the health care system spends too much trying to extend life was 79%, while only 21% believe the system should do whatever it takes. The younger the physicians, the more likely they were to support the relief of pain and suffering, as well as an increase of the quality of life, verses the extension of life at all costs. Personally, after seeing the pain and suffering my grandmother endured when her life was extended for years at the expense of comfort and quality of life, I am in full support of palliative care. She lived until the ripe age of 95, but a majority of the last 3 years of her life were spent incapacitated in hospitals. She is not the only elderly person I have know who was ready to go to a better place long before they got to the point of not being able to survive without constant medical care. She said herself that she thinks the medical advances that have been made might have gone too far. Perhaps it’s not that they have gone too far, but we have not approached the difficult questions medical advances have created, such as, when is it OK to let someone die naturally when we have the technology available to keep them alive. 

Physicians Push For More Palliative Care Despite Barriers

By Jessica Marcy

November 15th, 2011, 4:59 PM

A poll released Tuesday found that an overwhelming majority of doctors support palliative care, with 96 percent responding that they believe enhancing the quality of life for seriously ill patients is more important than extending life as long as possible. Despite these sentiments, many physicians responded that they have some hesitations about palliative care and that there are barriers to its full adoption.

Notably, the poll, released by National Journal and The Regence Foundation, also found a dramatic “generation gap” in physicians’ education and training on palliative care. Seventy-three percent of physicians age 39 or younger report “a great deal” or “some” exposure to palliative care during medical school compared to 36 percent of those age 40-49, 23 percent of those age 50-59, and only 6 percent of those age 60 or older.

Speaking at a National Journal event Tuesday, oncologist and bioethicist Ezekiel Emanuel, who currently teaches at the University of Pennsylvania, called upon the medical community to push for even greater incorporation of palliative care into the health system. Emanuel, the brother of Chicago Mayor Rahm Emanuel, said that his own career illustrates the major transformation in end-of-life care training. In 1984, during his third year of medical school, he decided to switch gears to pursue a PhD on end-of-life care issues, noting that his adviser told him, “That’s a career ender. Nobody wants to talk about end-of-life care.” Despite such initial discouragement, he went on to incorporate palliative care in oncology treatment at the Dana-Farber Cancer Institute and later served as the founding chair of the Department of Bioethics at the NIH Clinical Center until last August and as a special health policy adviser at the White House, where he raised attention about ethical issues in end-of-life care.

Emanuel emphasized that the greatest challenge may be simply preparing physicians to talk about end-of-life care with their patients, noting that it can be an intensely emotional and difficult conversation. Meanwhile, the poll found that 91 percent of physicians believe patients are not adequately informed about palliative care; other physician concerns include that patients are reluctant to accept it because it means they might not recover, health insurance companies and Medicare don’t reimburse adequately for consultations, there aren’t enough palliative care physicians and services and patients can’t afford the care.

The poll found that 79 percent of physicians think the health care system spends too much trying to extend life while 21 percent believes the system should do whatever it takes. Many physicians also reported that they received little training on operational and financial aspects of palliative care and that they would like more on those topics.

Shannon Brownlee, the New American Foundation’s acting health policy director, expressed concerns that the current reimbursement system inhibits the full use of palliative care, which would lead to the reduction of expensive treatment. “This is the horrible dilemma that hospitals find themselves in,” Brownlee said. “When you reduce that volume, you’re punished.”

Emanuel said that at some point insurers and Medicare will have to “make a leap together” to better support paying for palliative care. Emanuel, recalling Republican charges that the 2010 health law would establish “death panels,” noted that such political tactics “completely backfired.” Instead, he said they reinvigorated physicians’ efforts to improve end-of-life care.

“My inbox was flooded with support from physicians and it renewed the recognition by physicians that we have to do something on this,” Emanuel said.

The poll, conducted by FTI Consulting, surveyed 500 board-certified physicians, 45 percent of whom were primary care providers and 55 percent specialists between Oct. 28-Nov. 2. The poll has a margin of error of plus or minus 4 points.

Updated at 10:30 a.m. on Nov. 16 to correctly identify the poll sponsors.

This entry was posted on Tuesday, November 15th, 2011 at 4:59 pm.

 

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