Two bills in Congress could boost quality of life for patients
I t’s no secret that Americans are living longer lives. Our health care system does a better job than ever of managing previously fatal diseases. But our capacity to address the symptoms and stresses caused by these diseases is not keeping pace.
From my experience as a physician, as well as f rom my t ime a s president of the American Academy of Hospice and Palliative Medicine, I am very fami liar with the physical and mental blows a serious illness can strike. Diseases such as cancer, dementia, diabetes and heart disease have the potential to cause not only deep physical harm but also emotional and financial harm.
Palliative care seeks to soften these blows. By bringing a team approach to medicine that involves physicians, nurses and other specialists, we can address not only the disease itself but also its symptoms, including those caused by treatment. When done well, palliative care enhances a patient’s quality of life at any stage in treatment, improves health outcomes and achieves greater efficiency in our health care system, while ensuring patients remain in control of their choices.
I have seen patients express their desire to step back from aggressive, distress-generating treatments because they realized they were approaching the end of their lives. In such cases, comfort care is the primary focus. Others benefited by having comfort-directed measures given alongside such life-prolonging treatments. Palliative care adapts to the patient’s needs and desires and does not dictate what “should” be done.
So what’s keeping palliative care from being widely available? We’ve made a lot of progress for a new specialty in a short period of time, but we have a lot further to go with a need for more trained clinicians and for increased public awareness. A 2010 report from the American Academy of Hospice and Palliative Medicine projected a five-fold shortfall in the number of hospice and palliative medicine physicians necessary to staff existing programs at hospices and hospitals—and that doesn’t even count nurses and other professionals. This shortfall critically impairs our ability to educate patients about their treatment options and to provide the services they need.
Until we create system-wide incentives and ensure the availability of trained professionals and adequate resources, we will be unable to meet the need for palliative care. Congress is now considering a pair of bills that would expand the availability and improve the quality of palliative care.
• The Palliative Care and Hospice Education and Training Act (H.R. 1339 and S. 641) would increase the number of permanent faculty in palliative care at medical schools, nursing schools and other programs; create incentives to improve the training and retraining of palliative care professionals; establish Palliative Care Education Centers at medical schools; and promote fellowship programs.
• The Patient Centered Quality Care for Life Act (H.R. 1666) would expand research into palliative care, create a workforce training initiative to ensure sufficient numbers of health pro- fessionals at all levels to directly provide high quality palliative care for the highest risk and most complex patients, and convene health professionals, patients, public and private payers, and state and federal health officials to develop solutions, tools and model best practices for providing better patient-centered care to individuals with chronic disease.
Two Texas lawmakers—U. S. Reps. Gene Green, D-Houston and Filemon Vela, D-Brownsville— have already stepped forward to co-sponsor these bills. I hope more members of our Texas congressional delegation will soon join their ranks.
Every day we spend without addressing the issue of palliative care in America is another day of unnecessary suffering for patients with serious illness, stress for their families and wasted health care dollars for our society. Crossno, a Rockdale physician, was president of the American Academy of Hospice and Palliative Medicine in 2011 and is the senior national hospice medical director for Gentiva Health Services.