Liv­ing a full life

Pal­lia­tive care should be an op­tion for all crit­i­cally ill pa­tients around the coun­try.

Houston Chronicle - - FROM THE COVER -

Most of us know of ill pa­tients who are ag­gres­sively treated, only to die af­ter much suf­fer­ing. Many pa­tients be­lieve they have two op­tions: ag­gres­sive treat­ment or death. There is an in-be­tween op­tion, but too of­ten, pal­lia­tive care or learn­ing to live with a se­ri­ous or end-oflife dis­ease is not a con­sid­er­a­tion.

Pal­lia­tive care — which is as­so­ci­ated with bet­ter qual­ity of care — should be an op­tion for all crit­i­cally ill pa­tients around the coun­try. More­over, it should be an op­tion that is listed up-front, not some­thing that is only avail­able on spe­cific re­quest.

Texas is na­tion­ally and in­ter­na­tion­ally known for ag­gres­sive and ef­fec­tive end-of-life care, but our state lags be­hind the coun­try in of­fer­ing pal­lia­tive care, ac­cord­ing to the Cen­ter to Ad­vance Pal­lia­tive Care, which in its state-by-state re­port card on ac­cess graded Texas with a “C.” Only 66 per­cent of Texas hos­pi­tals with more than 300 beds of­fer pal­lia­tive care pro­grams and only 19 per­cent of hos­pi­tals with fewer than 50 beds.

In ad­di­tion, most pal­lia­tive care of­fer­ings are hospi­tal-cen­tric, mean­ing you have to be in a hospi­tal cen­ter or ac­tively dy­ing to have ac­cess to pal­lia­tive-care ser­vices. This leaves many peo­ple in our com­mu­nity fac­ing tough choices, such as whether to go on life sup­port or to ac­cept a feed­ing tube, with­out the op­por­tu­nity to con­sider pal­lia­tive care as an al­ter­na­tive.

Our health-care providers are bound by oath to do ev­ery­thing that they can to ex­tend lives, even af­ter pa­tients have lost con­tact with their loved ones and their mean­ing for ex­is­tence. Mak­ing pal­lia­tive care avail­able to a larger com­mu­nity could sub­stan­tially lower health-care costs, but more im­por­tant, it will re­duce suf­fer­ing.

Al­though Medi­care re­cently has be­gun of­fer­ing re­im­burse­ment for end-of-life talks, the ma­jor­ity of health pro­fes­sion­als to­day have had lit­tle to no train­ing in pain man­age­ment or skilled com­mu­ni­ca­tion around end-of-life sit­u­a­tions, ac­cord­ing to the cen­ter. Train­ing pro­grams are needed to meet the chronic short­age of pal­lia­tive-care spe­cial­ists and to fill a gap in pal­lia­tive-care skills among all types of clin­i­cians.

While ul­ti­mately state and fed­eral ac­tion is needed to ex­pand ac­cess to pal­lia­tive care, any suc­cess­ful ef­fort must start on the ground. Peo­ple of all ages need to be­come aware of the op­tion and to bet­ter un­der­stand it. A pa­tient can re­ceive pal­lia­tive care while pur­su­ing treat­ment for dis­ease. It is not “giv­ing up.”

In a unique col­lab­o­ra­tion, Memo­rial Her­mann, CHI St. Luke’s Health, Bay­lor Col­lege of Medicine, UT-Health and MD An­der­son Cancer Cen­ter, along with many other in­sti­tu­tions, have come to­gether to spon­sor an ef­fort to help ed­u­cate the pub­lic about al­ter­na­tives. Next Tues­day, in “Let Me Down Easy,” ac­tress Anna De­veare Smith chan­nels a num­ber of peo­ple — some fa­mous, and some un­known — to ex­plore is­sues sur­round­ing sur­vival, health care and mor­tal­ity.

For­mer Gov. Ann Richards who died of cancer in 2006, is one of those chan­neled by Smith. Richards was typ­i­cally feisty when she said, “I have two choices when I get up: I can feel good — or I can feel bad.” In the play, Smith shows how Richards was forced to adapt to live life fully to the end.

“If I fall, can you let me down easy baby,” go the lyrics to a pop­u­lar song. There are no easy an­swers to end-of-life de­ci­sions, but other cities and states have im­ple­mented pro­grams such as Hon­or­ing Choices in Min­nesota, Mas­sachusetts and Wis­con­sin that help peo­ple plan for the end of life.

With 2.5 mil­lion baby boomers turn­ing 70 last year, the largest med­i­cal cen­ter in the world needs to en­gage the com­mu­nity in a di­a­logue about how we live life to the fullest to the end. The col­lab­o­ra­tion around this play is a good start.

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