Palliative care in developed countries should improve

JAMA Surg. has published a report titled Palliative Care and End-of-Life Outcomes Following High-Risk Surgery (Original investigation). The issue has bioethics implications and is a matter that concerns the difficulty of access to adequate palliative care even in developed countries. In fact, it is a biomedical priority often postponed even by the World Health Organization (WHO), (see Why is not palliative care included in WHO Universal Health Coverage (UHC) goals?).

The authors begin with a question, What is the role of palliative care in the care of patients undergoing high-risk surgery and the association between palliative consultations and end-of-life outcomes of patients who died after surgery?

The methodology used

The study analyzed the use of perioperative palliative care and its association with family-reported end-of-life experiences of patients who died within 90 days of a high-risk surgical operation. It was conducted in the Department of Veterans Affairs (VA) Healthcare System. Patients who underwent any of 227 high-risk operations a total of 95 204 patients in the three years study.

The authors present their results in figures:

The 90-day mortality rate was 6.0% (5740 patients) varied by surgical subspecialty.
A multivariate mixed model revealed that families of decedents ( deceased person) who received palliative care were 47% more likely to rate overall care in the last month of life as excellent than those who did not. Of the entire cohort (95204),
3374 patients (3.75%) had a palliative care consultation, and
770 patients (0.8%) received it before surgery. Of all decedents,
1632 (29.9%) had a palliative care consultation, with 319 (5.6%) receiving it before surgery.

Conclusions of this large study

The authors concluded that “Receipt of a palliative consultation was associated with better ratings of overall end-of-life care, communication, and support, as reported by families of patients who died within 90 days of high-risk surgery” but pointed out that “Only one-third of the decedents were exposed to palliative care.”

As a final comment, the authors suggested that “Expanding integration of perioperative palliative care may benefit patients undergoing high-risk operations and their families.”

A bioethical and humanitarian approach

From a bioethical point of view are urgent humanize end of life care and significant improvement in palliative care from the diagnosis with a specialized and trained multidisciplinary team of medical professionals.