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Palliative Care in Utah
By Gregory J. Miller, M.D.
Palliative Care
Palliative care is the comprehensive management of a patient's physical, psychological, social, spiritual and existential needs. It can be part of the treatment of any person with a serious or life-threatening medical condition for which a patient-centered approach, pain and symptom control, family involvement and compassionate care are needed.
The following Precepts of Palliative Care, developed by the Last Acts Palliative Care Task Force, affirm a vision of better care at the end of life:
- Respecting patient goals, preferences and choices
- Comprehensive caring
- Utilizing the strengths of interdisciplinary resources
- Acknowledging and addressing caregiver concerns
- Building systems and mechanisms of support
Palliative care affirms life and regards dying as a natural process that is a profoundly personal experience for the individual and family. Palliative care neither hastens nor postpones death, but rather seeks to relieve suffering, control symptoms and restore functional capacity while remaining sensitive to personal, cultural and religious values, beliefs and practices.
Utah physicians are establishing palliative care programs in all areas of health care. For example, Dr. Sharon Weinstein is the Director of the Integrated Palliative Care Program at the Huntsman Cancer Institute, Dr. Sarah Goodlin is the Medical Director of the Supportive Care Program at LDS Hospital, and Dr. Greg Miller is the Medical Director of the Palliative Home Care and Hospice Program with Intermountain Healthcare. These physicians, along with others, are establishing programs that will provide palliative care throughout the health care continuum in hospitals, outpatient facilities and in homes.
Pain
Pain is the number one underdiagnosed and undertreated symptom in the United States. Pain is a problem that crosses all social and cultural lines. It is an unpleasant sensation and an emotional response to that sensation. Pain is a personal experience and unique to each individual.
Over 75 million Americans live with serious pain. Fifty million suffer from chronic pain and each year another 25 million experience acute pain as a result of injuries or surgeries. Forty-five percent of all Americans seek care for persistent pain at some point in their lives. The personal consequences of mismanagement of patients suffering from pain are immeasurable.
Fortunately, there has been national focus placed on pain assessment and treatment. For example, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has established pain management standards effective January 1, 2001. The majority of health care providers are accredited by JCAHO, and, therefore, all have developed new policies and procedures that are compatible with JCAHO's pain management standards.
Many institutions refer to pain as the "fifth vital sign." This means that every time someone has their blood pressure, pulse, respiration and temperature taken, they also are assessed for the intensity and quality of pain.
In the words of JCAHO, "Pain can be a common part of the patient experience; unrelieved pain has adverse physical and psychological effects. The patient's right to pain management is respected and supported. The organization plans, supports, and coordinates activities and resources to assure the pain of all individuals is recognized and addressed appropriately." All patients in all health care settings should expect and demand ongoing assessment and treatment of their pain.
Contributed by Gregory J. Miller, M.D.,
Medical Director of Supportive and Palliative Home Care
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