Loss of palliative care is a community's loss - Salish Current
May 19, 2023
Loss of palliative care is a community’s loss
Margaret Jacobson

Specialist palliative care providers “meet people where they are,” in hospitals, homes, care facilities and shelters; discontinuing teams serving this area is seen as “a huge loss.” (Photo by National Cancer Institute on Unsplash)

May 19, 2023
Loss of palliative care is a community’s loss
Margaret Jacobson

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The essays, analyses and opinions presented as Community Voices express the perspectives of their authors on topics of interest and importance to the community, and are not intended to reflect perspectives on behalf of the Salish Current.

Palliative care is multidisciplinary care for patients with advanced serious illness. It focuses on relieving pain and other distressing symptoms to improve quality of life. It can be delivered concurrently with life-prolonging treatments, much earlier in a patient’s disease trajectory, which differentiates it from hospice care. 

Palliative care offers equal or better survival benefits to chemotherapy in patients with advanced lung cancer, significantly reduces hospital length of stay and readmission rates, and is an important quality indicator across multiple medical disciplines.

Currently, there are over 100 patients served by the PeaceHealth outpatient/home-based program. These outpatients have a variety of life-limiting diagnoses, including heart and lung disease, kidney disease, neurodegenerative disease and cancer. Patients with advanced disease have complex symptom management problems, including intractable pain, shortness of breath, nausea, constipation, depression, anxiety, and existential and spiritual distress. 

These patients will be abandoned when the outpatient program shuts down. The small staff remaining (one nurse and social worker) cannot meet the demand for specialized palliative care. Even if these 100+ patients can be transitioned to community providers who will prescribe medications for them, future eligible patients will not have access to the multidisciplinary assessment and symptom management expertise that the outpatient program currently offers.

To contextualize this outpatient palliative care program within the current opioid epidemic: these patients are the hidden victims of the crisis. Patients with cancer — those with invasive tumors that erode bone and other viscera for example — often have severe and unremitting pain. These patients benefit from a variety of modalities, including opioids, radiation, nerve blocks and other treatments that improve pain and allow them some measure of comfort. 

Physicians in our community, regardless of specialty or discipline are often reluctant to adequately treat severe pain for several reasons: some have never been taught how, they fear their licenses are at risk if they prescribe an opioid because they don’t know or understand the Washington state pain regulations, they conflate physical dependence on an opioid with addiction, and they are uncomfortable with opioid pharmacology. 

Patients who desperately need these medications are routinely denied them by wary, insecure physicians who have a misplaced fear of contributing to the opioid crisis. Specialty palliative care physicians are experienced opioid prescribers, who operate with significant attention to patient and community safety. They can, and do, aggressively manage severe pain, and advocate with insurers, the state, drug formularies and pharmacies to ensure safe and best available specialty treatment for the patients under their care.

Securing inpatient and outpatient palliative care programs at PeaceHealth was a decade-long process. It began with the passage of the Washington state right-to-die legislation. At that time, those of us on the PeaceHealth system Ethics Committee, along with the Sisters of St. Joseph of Peace, understood that if PeaceHealth opposed this legislation, they must offer impeccable, state-of-the-art end-of-life care. 

Palliative care and hospice care were considered essential to that mission. Soon after, a contingent of us went to the Center to Advance Palliative Care training to learn how to establish a palliative care program in our community. I, along with several other community members, approached prospective donors with this request and promise: If they would give us the seed money to start a program, PeaceHealth would commit to funding it on an ongoing basis. 

Since then, this has been a repeated promise to donors: help us start it, and PeaceHealth will keep it going. Donors then and now understood that any clinical service dependent solely on philanthropy was doomed to failure — threatened always by the capricious nature of fundraising cycles. Our generous funders made their donations contingent on PeaceHealth providing ongoing operational support. By dismantling the palliative care program, PeaceHealth has essentially reneged on its promises to donors and the community and lied about its commitment to becoming a center of excellence in end-of-life and serious illness care.

Why should we be outraged? Since their inception, the specialist palliative care teams at PeaceHealth have provided evidence-based, multidisciplinary care that is congruent with patients’ goals and values. They meet people where they are: in the hospital, at home, in care facilities and in shelters. They meet people where they are emotionally, psychologically, and spiritually as well — helping patients develop an understanding of their illness and their treatment options. They model how community-based health care should be delivered to all patients with serious illnesses, including mental illness. These teams truly “see” patients. It will be a huge loss to our community to see them dismantled.

— Contributed by Dr. Margaret Jacobson

We welcome letters to the editor responding to or amplifying subjects addressed in Community Voices. If you wish to contribute to Community Voices, please send an email with a subject proposal to Managing Editor Mike Sato (msato@rockisland.com) and he will respond with guidelines.

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