7 June 2019
In the last few weeks an editorial in the BMJ has led to an interesting debate regarding when palliative care should be offered to patients with a cancer diagnosis, the level of integration it should have with oncology services and the attitude of the public and professionals associated with referrals to palliative care.
Within this editorial Dr Kirsty Boyd, a consultant in palliative medicine and Macmillan Honorary reader in palliative care, suggested that, in response to palliative care being linked inextricably with death and dying in the minds of professionals and the public, that it was being rebranded as ‘Enhanced Supportive Care’ in order to make it more socially acceptable. She went on to point out that the Enhanced Supportive care model of embedding palliative care within oncology services might be confusing for patients and families. Instead of this ‘rebranding’ she made a case for the use of consistent and positive language when discussing palliative care issues. She believes that the use of terms such as ‘ceiling of care’ or talk of ‘withdrawing treatment’ gives the impression that the patient is being denied potentially helpful interventions. She did recognise that the expertise of palliative care teams should be accessible to patients from early in the course of their final illness but made a plea that the attitude of professionals should be positive and a referral to palliative care put forward as an opportunity to obtain expert advice.
In a response to this piece Dr Richard Berman, (consultant in palliative medicine at The Christie and clinical lead for Enhanced Supportive Care) pointed out that Enhanced Supportive Care is not simply a euphemism for palliative care but is a model for integrating supportive care within cancer centres as a way of addressing the increased numbers of patients living with a cancer diagnosis. Even though specialist palliative care is an important element of supportive care; rehabilitation, secondary cancer prevention, and survivorship are also integral to it. Supportive care therefore has a wider scope than traditional palliative care. Dr Berman recognised that some palliative care teams had redefined themselves as ‘supportive care teams’ and that this had the effect of increasing numbers of referrals and earlier referrals to these services which he hailed as a positive effect. Despite this, he believed there should be more consistency in the way the term ‘supportive care’ is used and how it is put into practice.
In a different response to Dr Boyd’s article another respondent, a medical student, stated that the stigma associated with referrals to palliative care will only be reduced and more positive attitudes will only be fostered by increased levels of education for doctors during their training and a more open debate around palliative care and end of life discussions across society as a whole.
This discussion is relevant for oncology nurses as it raises questions about how, and when we refer to palliative care and whether there is a more integrated, supportive’ care model which involves us working more obviously in tandem with nurses and doctors with palliative care competencies and training.
The original editorial and responses can be viewed here.
Dr Richard Berman will chair an interactive session on Enhanced Supportive Care at the UKONS
Conference in November 2019. Tickets for the conference are available here.
Please continue the conversation via the UKONS twitter feed at @ukonsmember