Palliative Care Relieves Symptoms, and Extends Lives

The evidence for the benefits of palliative care is growing. Palliative care is a comprehensive service that improves the quality of life for patients with serious illnesses. It helps patients receive adequate pain and symptom management, avoid inappropriate prolongation of dying, helps patients achieve a sense of control over their illness, as well as helps them make the most of their remaining time.  It is a consultative service where caregivers from various disciplines work together as a unit to consider the list of symptoms and needs of the patient, and then create a practical plan for addressing the physical, emotion, social, cultural,  and spiritual needs to the furthest extent possible. 

From an empathetic and economic perspective, palliative care makes sense; and now a new study shows that palliative care and end-of-life planning when offered early in the diagnosis helps cancer patients lead longer and better lives.  In the 3 year study, 151 patients with advance lung cancer received cancer treatment as well as palliative care.  These patients lived two months longer than those who received cancer treatment without palliative services, and showed marked improvement in overall quality of life.  The study was published in the Aug. 19 issue of the New England Journal of Medicine.

“We were surprised by the magnitude of impact that palliative care had on quality of life, which normally decreases over time in these cancer patients, and the magnitude of the impact it had on depression. The survival benefit was the most surprising thing. Cancer care and palliative care are not mutually exclusive. Providing both is not only feasible, but beneficial. “  Jennifer S. Temel, MD, oncologist at Massachusetts General Hospital (MGH) Cancer Center in Boston and co-author of the study. From: “Cancer Patients Live Longer With Palliative Care,” on WedMD, August 19, 2010. http://tinyurl.com/2arjtno

In fact, psychological and emotional assessments are extremely important in identifying feelings of anxiety, depression, loss of dignity, and helplessness that can result from patients facing or fearing lack of control. Psychological distress can have devastating consequences for the patient, including amplifying the intensity of pain and diminishing the ability to make appropriate treatment decisions.

Ideally, palliative care should begin at the time of diagnosis. However, only 75% of hospitals offer palliative care, it is often offered towards the final days of life, and many physicians fail to offer it to their patients at all, often due to a “rescue mentality” where death is seen as failure.  But palliative care can assist patients and their families in making better decisions about what is helpful and what is fruitless, and help make their time together a healing experience.  Patients and their families need to ask for these services from their physicians and local hospital systems.

“The mission statement of every health system I know is it provide the best care we possibly can to families and patients who will want to come back and see us again. Palliative care fits right in with the mission statement of every health system that I know.” - Thomas Smith, MD, FACP, Medical Director of the Thomas Palliative Care Program at the Virginia Commonwealth University Massey Cancer Center.

Physicians, nursing staff, chaplains, social workers, physical therapists…all those involved in the care of patients can benefit from training on how to provide physical, psychological, social, cultural and advance-care planning assessments; offer patient and family education; have crucial conversations regarding tough decisions; and learn the clinical symptoms of impending death.  Envision, Inc. has an award-winning video developed in conjunction with the Thomas Palliative Care Program, and is ideal for Veteran Affairs hospitals and other health care facilities wanting to improve their end-of-life programs.   For more information on the video, and to see a free preview prior to purchase, please visit  http://www.envisioninc.net/index.php/programs/details/to_care_always_quality_care_at_the_end_of_life/.

Healthcare Worker Influenza Vaccination: Save A Life Today! (It Just Might Be Your Own)

According to flu.gov, in an average year, 5 to 20% of the population will contract seasonal influenza. 200,000 people are hospitalized from flu-related complications, and approximately 36,000 people will die from it.  There is a significant amount of literature that points to the reasons for the spread of influenza: poor hand hygiene, lack of proper respiratory etiquette, and most notably, a lack of immunity to the virus.  While many people will carry a natural immunity from the previous year’s exposure to an influenza strain, strains vary from year to year; and many individuals are a risk of serious illness from influenza should they catch it.  

The start of the flu season will be upon us soon, and once again healthcare workers as a group have an opportunity to decrease the spread of influenza in our communities and in our healthcare facilities. How?  With vaccination.  It is one of the most important things that healthcare workers in hospitals and outpatient settings can do to prevent transmission of influenza to patients, and prevent catching the flu themselves.

The most efficient method of preventing these outbreaks and the associated morbidity and mortality is through pre-exposure vaccination. Healthcare personnel (HCP) are at high risk for acquiring influenza infection due to their exposure to ill patients as well as their exposure in the community. Because those persons who are at greatest risk of developing complications of influenza are exposed to healthcare personnel in a variety of in patient and outpatient settings, an important strategy to decrease exposure to these high risk individuals is to immunize healthcare workers. - APIC Position Paper: Influenza Immunization of Healthcare Personnel, 2008.

Many hospitals have set high benchmarks for personnel vaccination rates driven by research, accreditation requirements and mandatory vaccination policies. And yet, despite recommendations by the CDC, APIC, and other healthcare organizations, and despite the evidence that  vaccination can and does make a difference in lowering patient deaths by 40 percent and improving patient safety, healthcare personnel vaccination rates remain low.  What are the reasons for the 46% vaccination rate, and how can this be overcome?

Here are some interesting facts: Personnel who decline vaccination have egg allergy, religious or philosophical convictions, or a history of Guillain-Barre. But this is a small percentage of those who are unvaccinated year after year. It seems that the remainder are likely to be socially isolated from others who choose vaccination, or simply have misconceptions regarding vaccination.  This is why the most successful campaigns in hospitals today incorporate staff education to target individuals who persistently decline vaccination.

Envision, Inc. has created a 12 minute visual presentation to address questions and concerns staff may have about vaccination in an effort to promote their participation in an influenza vaccination program.  http://www.envisioninc.net/index.php/programs/details/dispelling_the_myths_influenza_education_vaccination_and_prevention/

This program will dispel some of the myths surrounding the flu vaccine by:

• Explaining modes of transmission and the impact on patients
• Describing symptoms of flu, risk factors for complications, and treatment options
• Outlining flu prevention techniques that reduce transmission
• Explaining vaccine options and their possible side effects
• Addressing the need for a declination statement if not vaccinated

Let’s make 2010 the most successful year for healthcare worker vaccination!  The life you save might just be your own.

Sources: Health-Care Worker Vaccination Rates Remain Perilously Low. http://www.sciencedaily.com/releases/2010/03/100317091255.htm

APIC Position Paper: Influenza Immunization of Healthcare Personnel. http://www.apic.org/AM/Template.cfm?Section=Home1&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTFILEID=11049

www.flu.gov

www.cdc.gov/flu/

Joint Commission monograph: http://www.jointcommission.org/PatientSafety/InfectionControl/flu_monograph.htm