12/19/11

BETHESDA, MD. – Palliative care still suffers from thinking about that the approach begins only in the last days of of a patient’s life instead of one that can begin as soon as some diagnoses are made, according to several speakers at a summit on palliative care sponsored by the National Institute of Nursing Research and National Institutes of Health partners.

One route to improving the understanding of palliative care is through rigorous research in both inpatient and outpatient settings to see what works, according to Jennifer S. Temel, MD, clinical director of thoracic oncology at Massachusetts General Hospital in Boston.

Dr. Temel made the case for the value of palliative care research when she discussed her recent study of early palliative care for patients with advanced lung cancer (N. Engl. J. Med. 2010;363:733-42).

In a randomized, controlled trial of 151 adults with metastatic non–small cell lung cancer, patients who received palliative care soon after their diagnoses had significantly less depression and anxiety, compared with controls. Another significant finding: The median survival was longer among patients in the early palliative care group, compared with controls (11.6 months vs. 8.9 months; P = .02).

Patients with advanced illnesses suffer from both physical and psychological symptoms, Dr. Temel said.

To help promote and enhance additional research in the field of palliative care, Amy P. Abernethy, MD, an oncologist at Duke University Medical Center in Durham, N.C., described the creation of the U.S. Palliative Care Research Cooperative (PCRC) group. Dr. Abernethy is the coprincipal investigator of the PCRC, which was established in 2010 and funded by the National Institute of Nursing Research. The PCRC is currently establishing research protocols and procedures through which palliative care researchers will be able to suggest topics and submit grant applications, said Dr. Abernethy. "We must focus our scope, choose studies carefully, and do them well," she said.

The need to engage patients and caregivers as partners in palliative care research was addressed in many talks, as was the need for better communication among clinicians, patients, and caregivers about palliative care. Dianne Gray, a parent advocate whose young son died of a rare genetic disease, spoke about the importance of communication between doctors and patients facing end-of-life issues and reminded clinicians that families want to work with doctors. But families also want honesty, even if the answer is "I don’t know," she emphasized.

In the summit’s closing keynote address, J. Randall Curtis, MD, director of the Harborview/University of Washington End-of-Life Care Research Program, Seattle, said that he believes that attitudes toward palliative are already changing. "Palliative care is much more broadly accepted as an important part of health care" in both inpatient and outpatient settings, he said in an interview.

"I think there is a growing realization that all physicians caring for patients with life-limiting or life-threatening illnesses need to have basic palliative care skills," although specialists can and should be called in for difficult cases, Dr. Curtis said.

Dr. Temel said she had no financial conflicts to disclose. Dr. Curtis has received funding from the National Institutes of Health and the National Institute of Nursing Research. The summit was sponsored in part by the Foundation for the National Institutes of Health and by Pfizer.

Heidi Splete is a senior writer with Elsevier Global Medical News.