When Is the Right Time for Palliative Care?

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The Patient-Centered Oncology Care 2014 meeting started off with a talk by Marian Grant, DNP, RN, CRNP, of the University of Maryland School of Nursing, on the topic of palliative care. Although palliative care is appropriate for patients of all ages and in any stage of a serious illness and can be provided alongside curative or disease-modifying treatments, she says she often gets called in very late to offer palliative care to patients.

“If you ask me the right time for palliative care for patients with cancer, I’m going to tell you the earlier the better,” Dr Grant said. “And that’s what the evidence supports.”

She also discussed hospice care, which is a form of palliative care. However, in order to receive hospice care, the patient has to have a prognosis of 6 months or less to less, which isn’t always easy to determine. The current way hospice is structured requires that most people give up oncology treatment to receive hospice care, and many patients are not willing to do that. The situation is starting to change, though.

The Affordable Care Act allowed concurrent hospice and palliative care for pediatric patients, and now a pilot program out of the Center for Medicare and Medicaid Innovation allows some organizations to offer concurrent care for adults as well. Aetna found that when people are allowed to have both hospice and palliative care, there was an increase in hospice. Up to 71% of Aetna’s enrollees in the Compassionate Care Program were getting hospice care.