The Growth of Palliative Care in the United States

Abstract

Palliative care has been one of the most rapidly growing fields of health care in the United States in the past decade. The benefits of palliative care have now been shown in multiple clinical trials, with increased patient and provider satisfaction, equal or better symptom control, more discernment of and honoring choices about place of death, fewer and less intensive hospital admissions in the last month of life, less anxiety and depression, less caregiver distress, and cost savings. The cost savings come from cost avoidance, or movement of a patient from a high cost setting to a lower cost setting. Barriers to expanded use include physician resistance, unrealistic expectations of patients and families, and lack of workforce. The future of palliative care includes more penetration into other fields such as nephrology, neurology, and surgery; further discernment of the most effective and cost-effective models; and establishment of more outpatient services.

Palliative care and intensive care integration

“…Although the necessity for the integration of PC in ICU and in what directions ICU could be developed by PC have been explained, developed guidelines in literature for successful application in practice are limited. Of all hospital units, as ICU is the unit with the most losses or where subsequent functional and cognitive impairments are observed, successful integration of PC services into the ICU could provide better quality at lower cost and with better patient and family satisfaction [45].…”

“…Post-traumatic stress disorder and family anxiety have been seen to be decreased and family satisfaction increased [45].…”

Develop and test a palliative care screening tool for rural patients with serious chronic illnesses: a study protocol

“…1 Despite vast healthcare expenditures, these patients receive poor quality of care, fragmented care, undertreated symptoms and distress, unmet care needs, lack of family support, high caregiver burden and poor education about selfmanagement of their serious conditions. 2 The rural elderly population, in particular, receives care at healthcare facilities with limited resources.…”

“…5,6 Palliative care is an interdisciplinary, specialized care that improves quality of life for patients with life-limiting illnesses through symptom relief, care coordination, patient/provider education, decision-making aids, and psychosocial support. [1][2][3] There are three levels of palliative care: primary, secondary, and tertiary. 7 Generalists deliver primary palliative care services, such as symptom management, care coordination, establishment of goals of care and patient/family support.…”

Maintenance of continuity of care in a rotating-physician model in an outpatient palliative care clinic

“…While the structure and utility of inpatient palliative care services, hospices, and palliative care units have been well studied * [1,2], more recent attention has focused on the delivery of ambulatory palliative care services [3,4].…”