2020; Volume 21, No 11, November
The following feature first appeared in Russian on the Kazakhstan Association for Palliative Care website. It has been condensed, translated and edited.
Advocacy Toolbox: Persuasive arguments for governments to enact palliative care
By Gulnara Kunirova
IAHPC Board Member
Statistical indicators of morbidity and mortality alone can’t describe a nation’s state of health. Satisfaction with the quality of medical services also needs to be measured.
Two years have passed since the government of Kazakhstan and all UN member states adopted the Declaration of Astana, which includes palliative care in primary health, yet no serious strategic steps have been taken to properly introduce it into the public health system. If the humanistic goal of ensuring quality of life for their seriously ill and dying citizens – an “ethical imperative” according to World Health Assembly Resolution 67/19 — fails to persuade governments to develop palliative care, let’s see what other arguments we can present to describe its benefits.
1. Palliative care is budget-friendly
“Investing in palliative care and hospice services would not only provide the type of care many people require and currently lack, it also makes sound economic sense.”
— Dr. David Henderson, President, Canadian Society of Palliative Care Physicians
U.S. Medicare data shows that a quarter of total health care costs are spent in the last year of life.1 Recent randomized controlled trials show that switching from conventional hospital care to outpatient palliative care can save 30% in health care costs; it also frees up hospital beds.
2. Palliative care can reduce clinical costs
In 2016, researchers from Johns Hopkins Medical Institutions calculated that, over one year, instituting in-hospital palliative care consults and opening an 11-bed palliative care unit saved millions.2 “The perception is that palliative care and hospice is at best a break-even situation,” said co-author Dr. Thomas J. Smith. “But we showed that it saved the health system and society more than enough money to cover the cost of these services.” The savings were primarily due to the ability to avoid hospitalizations during the last 30 to 45 days of a patient’s life.
3. Affordable palliative care relieves social tensions
The burden of caring for a person with life-limiting illness usually falls to family members, reducing their standard of living and economic well-being, and increasing psychological tension between relatives as well as the risk of developing depression, etc.
In Kazakhstan, hospice care is only available in large cities. The result is visits to clinics where doctors or nurses have no knowledge of pain therapy or symptom management, emergency responders who helplessly shrug their shoulders, public posts brimming with pain and despair... Every year, about 135,000 people are in need of palliative care in Kazakhstan. That number doubles or triples when the needs of a family member or two are added.
4. Palliative care increases patient satisfaction
Surveys show that patients overwhelmingly measure satisfaction of care by the quality of interactions with medical personnel: their ability to listen, patience, compassion, moral support, being polite and respectful. These are the qualities endemic to palliative care, which is concerned with the psychological, social, ethical, and spiritual aspects of a person's life.
A side effect of the introduction of palliative care in any medical institution is the increase in the level of satisfaction with the quality of services. Why are we ignoring this?
5. Palliative care elevates overall clinical practice
The presence of even one well-trained palliative care doctor can increase the level of professionalism among colleagues and the quality of services provided in this institution. How? The practice of palliative care is to continuously develop effective ways to assess and relieve a wide range of symptoms that accompany the developing pathological process: chronic and breakthrough pain, side effects and complications of special treatment, mental disorders, emergency conditions. This bulk of knowledge and skills determines the quality of life of patients, and is also at the interface of accompanying therapy and rehabilitation.
6. Palliative care reduces the risk of burnout
“Failure to heal” may be an emotional burden for doctors: it is relieved when they can entrust patients with life-limiting conditions into the caring hands of a specially trained team. Psychologists working in a palliative care team include in the sphere of their professional attention the emotional state of their colleagues, and take measures to reduce stress and prevent burnout.
7. Palliative care can improve health statistics
While patients and their families value quality of life, and life well lived every day, life expectancy is also an important statistical indicator for cancer care services. One systematic review of randomized controlled trials concluded that patients with advanced cancer who received outpatient specialty palliative care lived longer and had better quality of life.3 An incurable patient can fall between the statistical cracks. A well-established and functioning palliative care service should improve the accuracy of death registries and produce better data.
Our health care system takes care of a person before, during, and after their birth, but for some reason leaves us without proper attention at the most critical and meaningful moment of our lives — before death. Palliative care helps people to devote this important time to sharing precious moments with family, reflecting on life’s path, completing earthly affairs, fulfilling cherished desires, or passing on valuable experience and knowledge.
For this to occur, the government must be the primary stakeholder in enacting palliative care for and with its citizens.
References
1. Riley GF, Lubitz JD. Long-Term Trends in Medicare Payments in the Last Year of Life. Health Serv Res 2010; 45(2): 565-576.
2. Isenberg AR, Lu C, McQuade J, Chan KKW, Gill N, et al. Impact of a New Palliative Care Program on Health System Finances: An analysis of the palliative care program inpatient unit and consultations at Johns Hopkins Medical Institutions. J Oncol Pract 2017; 13(5): e421-e430.
3. Hoerger M, Wayser GR, Schwing G, Ayako Suzuki A, Perry LM. Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults with Advanced Cancer: A meta-analysis of randomized controlled trials. Annals Behavioral Med 2019; 53(7): 674-685.
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