Lost in The Pursuit of Immortality. A Quality Care Initiative

More than half of all American adults experience tremendous pain and suffering in their last months of life, young and old alike. And, although the majority of people express their desire to die in the familiar comforts of their own home, an overwhelming number of them will die in the hospital. This brings about a ripple of effects that extend beyond the dying individual to their family, their caregivers, and their communities, ultimately resulting in significant loss of dignity. It consumes our humanity and our healthcare resources, all at enormous emotional and financial cost.

Palliative care is a model of care that despite its advantages, is often overlooked and underutilized in a climate of often painful and unrealistic expectations. Palliative care has the potential to relieve pain and suffering for those afflicted with serious illness and provide the support they, and their families need, as well as ease the financial burdens associated with end-of-life care.

Searching for Budget Solutions

In the United States, as healthcare becomes more complex and costs continue to escalate, healthcare systems, payers, and providers search for ways to contain their budgets, and researchers seek solutions aimed at reducing costs by using early discharge planning techniques to decrease unplanned readmissions, shorten hospital length of stay (LOS) and improve coordination of services. (Gonçalves-Bradley et al., 2016) At the same time, advancements in technology are allowing patients with chronic, life-limiting illnesses to live longer through the development of ever more aggressive and high-cost medical treatments that “incur the highest per capita healthcare costs” (Fine, 2004) that are often at the expense of the quality of a person’s life. Palliative care programs provide an option that has the potential to ease the burdens of painful and ultimately ineffective treatments for this patient population and meet the goals of reducing unplanned readmissions and hospital LOS.

Specialized Team of Caregivers

Because of its distinctive characteristics, palliative care is administered by a specialized team who works in tandem with the medical team and consists of physicians, nurses, social workers, physical and occupational therapists, as well as psychological and spiritual support professionals. The goal of the palliative care team is to provide comfort by addressing issues caused by the physical and emotional pain or suffering associated with serious illness, while institutional goals include the reduction of recurrent hospitalizations and LOS that signify poor patient outcomes, as well as, the elimination of barriers to providing appropriate end of life care related to lack of knowledge and clinical expertise.

As America’s population continues to age and advances in technology are allowing them to live longer with chronic and life-limiting conditions, aggressive and often unwanted or unwarranted treatments are provided in a seemingly futile pursuit of immortality that puts a significant strain on patients, caregivers, and the healthcare system. The Center to Advance Palliative Care (CAPC) reports that access to palliative care that can help relieve pain and suffering for those afflicted with serious illness and provide much needed support but these programs are severely underutilized. Research suggests that in the absence of resources and education about palliative care services and their benefits, an individualized and effective discharge plan aimed at improving quality of care cannot be achieved.

A Collective Responsibility

It is the responsibility of nurses regardless of their level of practice to obtain the knowledge and skills that are needed to provide best evidence-based practice, and to lead the way for change and create a plan to answer the ANA’s call to action that will improve quality of life for patients and their families.

Palliative care is a model of care that despite its advantages, is often overlooked and underutilized in a climate of often painful and unrealistic expectations.”

References

• Aslakson, R., Cheng, J., Vollenweider, D., Galusca, D., Smith, T. J., & Pronovost, P. J. (2014, February 01). Evidence-Based Palliative Care in the Intensive Care Unit: A Systematic Review of Interventions. Retrieved May 20, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3924791/
• Fine, R. L., MD. (2004, July). The Imperative for Hospital-based Palliative Care: Patient, Institutional, and Societal Benefits. Retrieved May 27, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200661/
• Gonçalves-Bradley, D. C., Lannin, N. A., Clemson, L. M., Cameron, I. D., & Shepperd, S. (2016). Discharge planning from hospital. The Cochrane Database of Systematic Reviews, (1), CD000313. doi: 10.1002/14651858.CD000313.pub5
• Ranganathan, A., MD, Dougherty, M., MS, Waite, D., MSW, & Casarett, D., MD, MA. (2013, October). Can Palliative Home Care Reduce 30-Day Readmissions? Results of a Propensity Score Matched Cohort Study. Retrieved May 18, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791031/
• Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-based Practice. The University of Texas Health Science Center at San Antonio.