Trends in Palliative Care

In American healthcare, the first decade of the 21^st Century saw a substantial increase in emphasis on end-of-life care, through a rise in palliative and hospice programs. This is a wide field indeed, whose diverse practice ranges from accredited palliative care specialist teams in hospitals, pain relief workers in nursing homes, and hospice providers who care for a dying person in the home. These are welcome gains indeed, but unfortunately, they have yet to be matched by an increase in understanding, let alone regulation, of an amorphous industry that is relatively novel to most American health care consumers.

Between 2000 and 2008, the number of hospitals with over 50 beds with a palliative care team increased by over 125%. Twenty years ago hospice and palliative care were almost unheard of — now approximately half of all dying patients will receive some form of pain management care. These are relatively rapid advances, partly due to an increased awareness of the value of end-of-life programs, and partly the natural result of an aging population. Unfortunately, they did not come with the simultaneous development of a standards framework.

There is a general consensus that folding palliative care and hospice care more fully into general health care practice could have a wide range of benefits, in health care savings, improved quality of patient life, and even aid in curative treatments. How to go about achieving this, with such an expansive, multi-form, and various nationwide industry, is still anybody’s guess.

Healthcare policymakers are scrambling to catch up. In 2006 the Robert Wood Johnson Foundation, the largest healthcare philanthropy in the U.S., published “A National Framework and Preferred Practices for Palliative and Hospice Care Quality,” which sought to clarify the goals, and set voluntary best-practice standards for palliative teams and hospice care providers. Among other things, the report defined eight “domains” of quality palliative and hospice care that providers could strive for and consumers could compare to, and identified enduring barriers in effective palliative care and hospice care implementation, such as many families’ imperfect understanding of advance health care directives, and primary physicians’ ignorance of their patients’ preferences.

In April of this year, the Agency for Healthcare Research and Quality embarked on a comprehensive review of existing hospice care literature and statistical analyses, in an attempt to develop effective quality improvement strategies for closing what they call the “quality gap,” or the difference between what is being achieved through the system in practice, and what could be achieved, “on the basis of current professional knowledge.” Says AHRQ researcher Supriya Janakiraman, “One of our main goals here is to identify the glaring gaps in evidence, of which, unfortunately, there are many… If we want to improve the quality of hospice first we need to know more about how it’s being implemented.” This, of course, is quite the task in itself. The results of their study are due to be released before the end of the year. Hopefully there will be more like them to come.