A Conversation with Dr. Diane E. Meier
Dr. Diane E. Meier is director of the Center to Advance Palliative Care (CAPC), a national organization devoted to increasing the number and quality of palliative care programs in the United States. She is also director of the Lillian and Benjamin Hertzberg Palliative Care Institute; professor of Medicine and Geriatrics; and Catherine Gaisman Professor of Medical Ethics at Mount Sinai School of Medicine in New York City.
What are the challenges for palliative care in cancer?
One challenge is the widespread myth that palliative care is the same as end-of-life care. Palliative care is distinct from hospice care in that it is appropriate for any patient with a serious illness, regardless of their prognosis. For example, our hospital palliative care program delivers care to young people with curable leukemias and curable Hodgkin disease, who are going through a very difficult time at diagnosis and during the aggressive treatments that they need to cure their diseases. What we try to do is make the experience of a serious illness more bearable for the patients and their families.
A second major barrier is the intense focus on disease-specific treatment in American medicine and the highly specialized, fragmented care that results. Most cancer patients in this country are over age 65. Most of them have multiple chronic diseases with cancer being only one of them. When a person of any age has cancer their oncologist usually becomes their de facto primary physician. Yet the problems of cognitive and functional impairment, multi-morbidity, fatigue, frailty, risks of falling, and exhausted and overburdened family caregivers are not things that oncologists are set up to handle. With the partnership of a palliative care team, these kinds of problems can be addressed at the same time that cancer treatments are administered by the oncologist.
What is on CAPC's research agenda?
Our research agenda is quite broad. We are tracking the growth of palliative care programs to assess access around the country. We will publish a paper at the end of this month in the Journal of Palliative Medicine that shows enormous variability in access to hospital palliative care programs, just as in every other aspect of the health care system.
We're also doing NCI-funded research to document the impact of palliative care on quality of life, patient and family satisfaction, need for hospital-level care (such as number of emergency room visits and days spent in an intensive care unit), and costs and efficiencies of care. Another paper published this week in the Archives of Internal Medicine demonstrates dramatic cost avoidance associated with palliative care in eight hospitals in low-, medium-, and high-cost markets.
Are there signs of progress in palliative care?
Palliative care is getting a lot of national recognition. The Joint Commission [an independent, not-for-profit organization that accredits and certifies health care organizations and programs in the United States] will soon launch a palliative care certificate program, in which hospitals apply to receive a certificate of quality for their palliative care programs. In addition, the National Quality Forum has published a framework and preferred practices for palliative care, so there are standards and guidelines to ensure the delivery of the highest possible quality of palliative care. Last year, the American Board of Medical Specialties approved palliative care as a sub-specialty with an unprecedented 11 "parent" specialty boards, including internal medicine, family medicine, and surgery. That's a real sign of the growing recognition of the value of palliative care for all kinds of patients with all kinds of medical problems.