Patients, Families and Providers Need to Be on the Same Page for Palliative Care

Across nearly two decades of working in oncology, Dr. Timothy M. Pawlik has seen attitudes regarding palliative care evolve first-hand.

“It would be very infrequent for us to call a palliative care consult or get them involved 20 years ago, and now it is much more routine,” Pawlik, the Urban Meyer III and Shelley Meyer Chair for Cancer Research and the chair of the department of surgery at the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center in Columbus, Ohio, told CURE.

Pawlik is the co-author of a study published in Annals of Surgical Oncology examining the disparities based in race, ethnicity and poverty regarding access to and utilization of opioids for end-of-life (EOL) pain management among patients with gastrointestinal cancers.

“We looked at utilization of medications, because we know at the end of the life pain control is super important and palliation is super important,” Pawlik said. “And we also know that we have made a very important effort to decrease opioid usage in all of medicine. That being said, at the end of life sometimes the use of opioids is important, because obviously you're not as concerned about addiction, because someone is very near the end of their life and they may be experiencing much more discomfort or pain. And although there are many ways to treat pain, at the end of life opioid use is potentially one way to alleviate suffering.”

Pawlik and his fellow researchers found that “race/ethnicity-based disparities in EOL pain management persist with SDoH (social determinants of health)-based variations in EOL opioid use. In particular, PP (persistent poverty) impacted EOL opioid access and utilization,” according to the study.

“We need to make sure that (for) palliative care — which is a distinct subspecialty of medicine (and) it's a very specific skill set — that all patients have access to robust palliative care towards the end of their life,” Pawlik said. “And … from a patient perspective and a family perspective, making sure that your goals are clear or articulated and are heard and those include, not infrequently, relief from suffering (is important). And I think it's important to have open and honest and clear conversation with your care providers around that, so that that is appropriately and adequately addressed.”

Transcript:

I think there's been enormous strides in the field of palliative care and also our view of palliative care of the last 20 years. I've been practicing surgery now for almost 20 years, and I know it would be very infrequent for us to call a palliative care consult or get them involved 20 years ago, and now it is much more routine. And I think it's also important to involve our colleagues in palliative care earlier on in the care continuum of patients.

And palliative care is much more than end-of-life care. End of life care is very, very important, but I think now most of us construe palliative care to be much broader in concept. And it is about aligning the patient's goals and the family's goals with the therapeutic goals.

Because sometimes, as a provider, I have the best intent, but what I think you may want may not be what you want. Because there are many things — there's live longer, be cured of my disease, be free of pain, have time with my family. We could go on and on, (there are) lots of different goals. So it's important for patients and families and care providers to really articulate those goals, and then have discussions about what interventions can we help with as care providers to help you realize those goals. Some, we'll be able to help you with. Others, we may not. But it's important to have those conversations.

Transcript has been edited for length and clarity.

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