Palliative Care and the Value Derived in Cancer Care
Palliative care, as the moderator, Thomas LeBlanc, MD, Associate Professor of Medicine, Associate Professor in Population Health Sciences, Member of Duke Cancer Institute, Duke University School of Medicine, acknowledged, is a loaded term. It can be difficult to know how to define or describe it because most people think it only pertains to death and dying, or that it is related to hospice care. In this breakout session with key opinion leaders, the discussion centered around definitions of palliative care and its place in the value equation.
In light of the definitional complexity, each of the experts approached the concept of palliative care differently and added their own nuance to the concept. Gena Cook, Founder/President, Navigating Cancer, stated that to her it means, “managing the whole person and all the things that come with their disease.” Sarah Beadling, Director, Operational Innovation, Cancer Treatment Centers of America, took a slightly different perspective. Ms Beadling maintained that one of the main goals of palliative care is to intervene in side-effect management so that patients can get back on—and stay on—their treatment plan. Finally, Torrie Fields, MPH, Senior Manager, Palliative Care Program Design & Implementation, Blue Shield of California, who revealed that she was herself a cancer survivor in addition to a palliative care advocate and manager, put forth the most comprehensive definition. Ms Fields formulated her definition based on the one developed by the Center to Advance Palliative Care (CAPC), a national organization dedicated to increasing the availability of quality healthcare for people living with serious illness. Ms Fields explained that she defines palliative care as specialized medical care for people with serious illness that is there to support the quality of life of patients and caregivers. It is best provided by a multidisciplinary team who can address a range of issues, including social and psychological problems. It can start at any time after diagnosis and is for anyone at any age at any stage of illness. It also involves advance care planning and shared decision-making and making sure the patient and family are at the center of care. Patients should understand their prognosis, their treatment plans, and options. Palliative care should also encompass pain and symptom management, and, finally, it should make certain to treat the person as well as the patient.
After laying down working definitions, the discussion moved to the questions of why we need to talk about palliative care, why it is a growing field, and why people are interested in it.
Ms Cook suggested that cancer programs had not been doing palliative care well until value-based care became more available. This is perhaps because implementing value-based care models led to “Helping people build a workflow that takes care of patients better.” Moreover, the Oncology Care Model incentives and value-based care concepts help keep patients out of the hospital. Palliative care interventions help to avoid hospital emergency department admissions. Ms Beadling finds her challenge is the cost involved in providing a high level of care and wants to find ways to employ palliative care to bring down costs. She added, “Emergency department and hospital admissions can be proxy for quality of care, but not quality of life.”