Ahead of the 15th World Congress of the European Association for Palliative Care, Professor Dr Claudia Bausewein, Director of the Department of Palliative Medicine at Munich University Hospital, Munich, Germany, gives a glimpse of the plenary lecture she will give at the congress in Madrid on Thursday 18 May 2017.
We are all very familiar with providing palliative care to people with advanced cancer. Service models have been developed, healthcare providers and politicians have understood the concept, patients and their families are widely demanding it. And we know from a number of high-quality studies that early integration of palliative care is crucial and beneficial to patients in many ways. We have not yet defined properly what early palliative care in cancer patients means exactly, but colleagues report that early integration is happening more and more often.
But the picture is slightly different when looking at patients who do not suffer from cancer! If you talk to a respiratory physician, or a cardiologist, or a neurologist, about their patients with advanced disease many of them would not automatically think of them as being in need of palliative care. Patients might complain of symptoms or declining functional status, or wonder what is coming next, but most would not consider themselves to be ‘palliative’. For many of them, palliative care is linked to cancer, the end of life and pain management. These myths about palliative care seem to be widely engraved on people’s minds. However, we know from studies that symptom burden, psychosocial, existential and information needs are high in COPD (chronic obstructive pulmonary disease), heart failure or Parkinson’s patients, not only at the end of life but much earlier in the disease trajectory. Disease trajectories vary widely in this group of ‘non-malignant diseases’ with repeated crises such as acute exacerbation or acute decompensation in organ failure, or more lingering decline in dementia and frailty. Prognosis is even more challenging than in patients with cancer.
Thinking about palliative care provision in patients beyond cancer raises many questions: When is the right time to start palliative care? What does ‘early palliative care’ mean in COPD, heart failure, MND (motor neurone disease), or Parkinson’s disease? Which model of palliative care would be best to meet patients’ needs? Who should provide palliative care? What does it mean in everyday clinical life to provide palliative care in relation to needs rather than diagnosis or prognosis?
There is a lot to consider and to discuss when facing these questions and there are probably no quick and easy answers! I will try to highlight some of these issues in my presentation at the EAPC Congress in Madrid and hope to stimulate further discussion and awareness of early integration of palliative care in patients with any disease!
Professor Dr Claudia Bausewein will give her lecture, ‘Beyond Cancer: Challenges and opportunities for early palliative care engagement’/ ‘Más allá del cáncer: retos y oportunidades para los cuidados paliativos tempranos’ in the Plenary Hall on Thursday 18 May 2017, at 14.40 to 15.10. Simultaneous translation into Spanish will be available for all plenary lectures. To view the full congress programme and to register, please visit the congress website.
Read more posts on the EAPC Blog about the Madrid Congress.