We have been talking about quality care at Palliverse this month a topic that has a lot of relevance to early palliative care. The WHO talks about early palliative care as meaning care that is offered at the time of a life-limiting diagnosis. In practice palliative care is often offered much later, and some have suggested that this means that real benefits are missed for many people.
The evidence to back this approach to care is increasingly compelling. Much of it arises from studies looking at quality outcomes for persons with cancer. The most noted study is a RCT from Temel et al which demonstrated an improvement in quality outcomes and survival when early integrated palliative care to usual care for lung cancer. However, multiple studies have demonstrated improvements in symptom management, and quality of life for patients, and improved outcomes for carers. This has led to a a recent update of the ASCO guidelines now suggesting that all patients with advanced cancer “should receive concurrent dedicated palliative care” with standard care early in the disease course.
Despite the focus on “dedicated” palliative care some aspects of what should be offered does not have to come from specialists. A recent article in the BMJ by Murray and colleagues comments that part of the challenge and the benefit of early palliative care lies within conversations. To offer early palliative care requires some acknowledgement of the uncertainties that anyone with an advanced illness faces. It is perhaps in exploring what this uncertainty means to patients and families that much of the benefit of early palliative care is realised. As they comment early palliative care in many senses is just good-quality patient centred care and planning, the sort of care that should be standard to all.
Early palliative care has the potential to benefit many. To be able to benefit the most people we need to learn from this evidence to improve the quality care offered to all people with advanced disease regardless of whether specialist palliative care services are involved. It is likely that what will be most important is not who provides this care and what it is called, but that it happens in the first place.
If you are interested in this topic you may also want to check out this podcast from the BMJ of an interview with Murray on this topic. A related video highlighting these ideas is also available here.