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END-OF-LIFE ISSUES | Globe Editorial

New impetus for palliative care

September 1, 2010

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ALL TOO often, patients with terminal illnesses turn to the pain medication and counseling of palliative care only after enduring wrenching treatments that have little chance of extending their lives. But what if palliative care began immediately after the diagnosis and while the disease is still being treated? The answer, according to a study at Massachusetts General Hospital, is that patients treated this way enjoy a higher quality of life and live longer. In addition, they are more likely than patients not receiving palliative care to forgo 11th hour therapies.

The outcome took experts by surprise, but not entirely. As Brigham and Women’s surgeon Atul Gawande noted in a recent article in The New Yorker, a study of 4,493 Medicare patients found that survival times for terminal patients receiving hospice care were about equal or longer than those of patients getting more aggressive treatment.

Studies like these show how foolish Congress was to drop a provision in the recent health reform law that would have allowed Medicare to reimburse doctors for end-of-life consultations with patients and their families. Congress rejected this sensible measure after Sarah Palin and other alarmists grossly mischaracterized it as “death panels.’’

The lack of Medicare reimbursement is just one reason that doctors, patients, and families rarely have the kinds of conversations that would result in patients dying peacefully at home, as most say they hope to do. The MGH study, reported in The New England Journal of Medicine, should spur more such talks, as difficult as they are for all sides. Patients getting palliative care also reported less depression, pain, nausea, and worry, and greater mobility. Plus, they lived on average almost three months longer than patients getting only conventional treatment. In its next session, Congress should give new life to end-of-life services.

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