Poll Reveals Challenges of Providing End-of-Life Care

Nov. 16, 2011 -- Though doctors nearly universally agree that helping patients die without pain is a more important goal than doing everything possible to prolong their lives, many say it can be tough to talk to patients about palliative care, a new poll shows.

The poll results were released by the National Journal and The Regence Foundation, the nonprofit arm of the Regence health insurance company. The results reveal some of the struggles doctors face caring for patients who are at life's end.

Palliative care is a kind of care for people who have serious illnesses. It is different from care to cure your illness, called curative treatment. Palliative care focuses on improving your quality of life not just in your body, but also in your mind and spirit. Sometimes palliative care is combined with curative treatment.

Survey Results

Out of 500 board-certified doctors surveyed, almost all said that when caring for terminally ill patients, it is more important to relieve pain and enhance quality of life than to use every possible medical intervention to try to prolong patients' lives.

But when that same question was posed to Americans in the general population, only 71% of them said they shared that belief.

"There is a pretty strong sense in the public and an overwhelming sense among providers that the goal should be to enhance the quality of life rather than just extending it to the last moment possible," says Ronald Brownstein, editorial director of National Journal. "But there are really significant cross pressures that play in and there are significance barriers to that kind of care being available and delivered."

One of those pressures, for example, was a belief among doctors that patients might see an attempt to bring up end-of-life care as a sign that their doctor had quit the fight for their lives.

About one in four doctors surveyed said they were reluctant to recommend palliative care for fear that patients would think they were not doing everything possible to extend their lives.

And 42% of doctors in the survey expressed concern that emphasizing palliative care couldinterfere with efforts to prolong life.

In a panel discussion that followed presentation of the poll results, experts pointed out that the two goals need not be mutually exclusive.

"Palliative care is a medical subspecialty that's appropriate for all patients with serious illness -- regardless of diagnosis or the stage of their disease -- that focuses on symptom management and pain control, but also the stress of serious illness and quality of life for patients and their families," says Amy S. Kelley, MD, assistant professor of geriatrics and palliative medicine at Mount Sinai Hospital in New York City.