Despite death being our only shared destiny, there is an amazing amount of misinformation about what medicine can achieve at the end of life
We are often told that we are not, as a nation, good at talking about death and dying, so it should come as no surprise that while we are all aware of the concepts of hospice and palliative care, we often have little understanding of their real potential. Glasgow-based GP Dr Margaret McCartney, writing for the Guardian, considers the 'misinformation' concerning palliative care, and looks at new research indicating that palliative care can extend life's quantity, as well its quality.
Metastatic lung cancer is hard to treat. So if there were a treatment for people with the disease that had minimal side effects, could extend not just the quantity of life but also its quality, we'd expect it to be a blockbuster. There is indeed such a treatment, as described in research published in the New England Journal of Medicine in 2010, but it's not a tablet. It's palliative care.
To many patients and their families, palliative care can sound like the end of the road. As a doctor I am often asked, isn't that for when things are hopeless? It's true that palliative care does not aim to cure disease but to treat its symptoms, from pain and anxiety to constipation. Good palliative care means measuring treatments in terms of what they do for quality of life - not what they do to the cancer on a CT scan.
So the results of the research are counterintuitive: patients who received early palliative care and less aggressive treatment lived longer...
As we are time and again reminded, palliative care consists of many different strands and ideas, and the challenge we all share is not only to continually improve provision but also understanding of palliative care.
This kind of information is very powerful when trying to weigh up the pros and cons of further treatment. Despite death being our only shared destiny, there is an amazing amount of misinformation about what medicine can achieve at the end of life...
Margaret McCartney, as well as recently publishing a book, Living with Dying - Finding Care and Compassion at the End of Life, also writes what has been hailed as a 'common sense' column for the British Medical Journal. Her conclusion for the Guardian is true to form:
It may be hard to talk about, but to get our death care better we have to know the facts about what is likely to help us at the end of our lives. Palliative care is pretty good.