___________________________________________ Palliative Care and Pain Management at the End of Life
DISTRIBUTION OF DIAGNOSES IN HOSPICE CARE, 2021
Cancer (29.6%) Circulatory/heart disease (17.4%) Dementia (15.6%) Respiratory disease (11.0%) Other (14.7%)
Source: [1]
Figure 4
BENEFITS OF PALLIATIVE CARE AT THE END OF LIFE Most of the studies designed to determine the benefits of pal- liative care/hospice at the end of life have centered on patients with cancer. However, an increasing number of researchers are focusing on palliative care interventions for patients with other life-limiting diseases. The field of palliative care/hospice research has grown considerably in the past decade, but reli- able meta-analyses of palliative care studies have been limited because of variations in methodology and in the focus and extent of services [45]. Increasingly, studies are confirming the benefits of palliative care/hospice in terms of quality of life, satisfaction with care, and end-of-life outcomes, as well as cost-effectiveness. A systematic review indicated weak evidence of benefit for pal- liative care/hospice. The results did demonstrate significant benefit of specialized palliative care interventions in four of 13 studies in which quality of life was assessed and in one of 14 studies in which symptom management was assessed [29]. However, the authors of the review noted that most of the stud- ies lacked the statistical power to provide conclusive results, and the quality-of-life measures evaluated were not specific for patients at the end of life [29]. Other research has shown that palliative care intervention was associated with significantly better quality of life and greater patient and/or family caregiver satisfaction [45; 46; 47]. Data to support benefit in reducing patients’ physical and psychological symptoms have been lack- ing [45]. Such symptoms were significantly improved when patients received care delivered by palliative care specialists [28].
Surveys of patients’ family members also demonstrate the value of palliative care. The Family Assessment of Treatment at the End of Life (FATE) survey was developed to evaluate family members’ perceptions of their loved one’s end-of-life care in the Veterans Administration (VA) healthcare system. FATE consists of nine domains: well-being and dignity, information and communication, respect for treatment preferences, emo- tional and spiritual support, management of symptoms, choice of inpatient facility, care around the time of death, access to VA services, and access to VA benefits after the patient’s death. Using the assessment tool, researchers found that palliative care and hospice services were associated with significantly higher overall scores compared with usual care [48]. In addition to the benefits realized by patients, palliative care is beneficial for patients’ family members as well. According to a survey of bereaved family members, a significantly higher proportion of respondents had their emotional or spiritual needs met when the patient received palliative care (compared with “usual care”) [49]. Palliative care was also seen to improve family member coping skills and the ability to manage the inevitable tasks associated with terminal illness; that is, more family members knew what to expect when the patient was dying, felt competent to participate in the care of the dying person, and felt confident in knowing what to do when the patient died [49]. Other studies have shown benefit for care- givers through positive effects on caregiver burden, anxiety, satisfaction, and the ability to “move on” more easily after the patient’s death [46; 50].
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MDCA1525
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