by Divine Grayson ’23

Palliative care has recently become a more prominent  path in healthcare. Palliative care is defined as specialized medical care that focuses on providing patients relief from pain and other symptoms of a serious illness, no matter the diagnosis or stage of the disease. Palliative care is often mixed up with hospice care, although hospice care can lie within palliative care. Hospice care is healthcare that focuses on the palliation of a terminally-ill patient’s pain and symptoms, attending to their emotional and spiritual needs at the end of life. If someone is in palliative care, that does not necessarily mean he or she is in hospice. Being a patient in palliative care also does not mean that one is not being treated for your disease. People with chronic conditions such as  heart disease, kidney failure, Parkinson’s disease, and dementia benefit from palliative care while also being treated for their conditions.  

People choose palliative care because they would prefer to choose how they spend their life as a person with a chronic condition. As stated before, palliative care is known for  relieving and managing pain. People with chronic conditions are often left in pain due to the effects the conditions have on their body, and having that continuous pain lowers their quality of life. Oftentimes, people who need palliative care do not get it early enough or at all due to the associated costs. Earlier intervention of palliative care has been shown to help patients live longer and feel better (2). I do want to point out the Rowland study because 97% of its participants were white, and so parts of the benefits may not transfer over to people of color due to other factors outside of their medical conditions.  

People do not receive palliative care for a variety of reasons. The negative stigma going towards palliative care has pushed people away from it. Since palliative care was first defined in the 1960s,  gender roles and norms such as “giving up” and “weak” were the first to be associated with palliative care. Men are typically the victims in this situation because they were supposed to “take it like a man.” This can lead to treatment and end-of-life quality being lower than what it needs to be. This does not have to be the case. As the younger generations start to come into age, many things considered taboo to the older generations are becoming destigmatized. As this new generation comes into the world — deciding the culture, what is valuable, and what we care about –the thought of someone using palliative care is not seen as “weak.” In fact, as Millennials and Gen X age, more of them look towards palliative care in the event that they need it (1).  

The cost of palliative care is something a lot of people cannot afford. Since the people who are most likely to be in palliative care are people with disabilities and the elderly, they typically have fewer job opportunities and less money. People with disabilities often must make under a certain amount of money in order to retain some benefits, which is another conversation in itself. The cost of palliative care is not expensive, compared to other hospital and medical costs, but it is more of an upfront cost. In fact, a study has shown that people who receive palliative care spend $4,000 less for a hospital visit than those who do not receive palliative care (3).  

Palliative care funding and resources are very limited. Federal funding for palliative care is very limited, and hospitals often have to pay for at least 50% of the palliative care programs (3). This means that hospitals will have smaller palliative care departments and centers, limiting  the number of patients they can care for. In the U.S., there is only 7600 palliative care doctors. The 7600 doctors practice in specialties such as  cardiology, oncology, and pulmonology. If the patient’s condition does not fit within the specialties where a palliative care certification exists, then getting a palliative care doctor. 

Palliative care is becoming increasing popular. The stigma surrounding palliative care is incredibly toxic; however, the conversation about palliative care is changing. As healthcare moves forward with a progressively aging population and increased caring about disabled people’s rights, the NIH has increased funding to palliative care. The availability of a palliative care specialist is becoming more frequent. The cost of palliative care specialist is becoming cheaper due to the increased funding, and centers within the United States are providing quality care.  

Resources

1. Hawley P. Barriers to Access to Palliative Care. Palliative Care: Research and Treatment. 2017. 
2. Rowland K, Schumann SA. PURLs. Palliative care: earlier is better. J Fam Pract. 2010;59(12):695-698. 
3. Sullender RT, Selenich SA. Financial Considerations of Hospital-Based Palliative Care. 2016.