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Opportunities to maximize value with integrated palliative care

Authors Bergman J, Laviana AA

Received 29 December 2015

Accepted for publication 26 January 2016

Published 5 May 2016 Volume 2016:9 Pages 219—226

DOI https://doi.org/10.2147/JMDH.S90822

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Video abstract presented by Dr Aaron Laviana.

Views: 32

Jonathan Bergman,1–3 Aaron A Laviana,1

1Department of Urology, 2Department of Family Medicine, David Geffen School of Medicine at UCLA, 3Veterans Health Affairs-Greater Los Angeles, Los Angeles, CA, USA

Abstract: Palliative care involves aggressively addressing and treating psychosocial, spiritual, religious, and family concerns, as well as considering the overall psychosocial structures supporting a patient. The concept of integrated palliative care removes the either/or decision a patient needs to make: they need not decide if they want either aggressive chemotherapy from their oncologist or symptom-guided palliative care but rather they can be comanaged by several clinicians, including a palliative care clinician, to maximize the benefit to them. One common misconception about palliative care, and supportive care in general, is that it amounts to “doing nothing” or “giving up” on aggressive treatments for patients. Rather, palliative care involves very aggressive care, targeted at patient symptoms, quality-of-life, psychosocial needs, family needs, and others. Integrating palliative care into the care plan for individuals with advanced diseases does not necessarily imply that a patient must forego other treatment options, including those aimed at a cure, prolonging of life, or palliation. Implementing interventions to understand patient preferences and to ensure those preferences are addressed, including preferences related to palliative and supportive care, is vital in improving the patient-centeredness and value of surgical care. Given our aging population and the disproportionate cost of end-of-life care, this holds great hope in bending the cost curve of health care spending, ensuring patient-centeredness, and improving quality and value of care. Level 1 evidence supports this model, and it has been achieved in several settings; the next necessary step is to disseminate such models more broadly.

Keywords: palliative care, end of life, integrated, urology

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