Dr. Lefkowits Addresses Misconceptions About Palliative Care Integration

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Carolyn Lefkowits, MD, gynecologic oncologist, and palliative care doctor, at the University of Colorado, addresses common misconceptions regarding palliative care integration.

The first misconception, according to Lefkowits, is the idea that a referral to palliative care means that the visit will only involve discussions focused on advanced care planning; however, there are data to refute that. In reality, the first palliative care visit will typically focus on illness understanding, coping strategies, and symptom management.

When these visits do address prognosis or advanced care planning, Lefkowits says that the palliative care specialist should be taking information on prognosis, disease-directed therapy options, and response rates from the oncologist. Oncologists should be providing these specialists with prognostic data, she stresses, and then the specialists will incorporate their expertise into goal-based decision making in order to help their patients choose the best path possible for them.

The second myth surrounding palliative care is that these visits will take away hope from patients. In one study of in-patients who received specialty palliative care, investigators asked participants how much distress they had due to uncertainty about what to expect from their illness. Three-quarters of the patients reported that they had at least moderate distress because they didn’t know what to expect in the future, says Lefkowits.

Further data suggest that after having advanced care planning conversations with patients is more helpful than harmful, in that depression and anxiety symptoms were found to decrease after these conversations. When specialists neglect to bring up these important factors, it can actually cause more distress, anxiety, and depression, due to fear of the unknown, she adds.

Sometimes, specialists will need to reframe or redirect hope for their patients, explains Lefkowits. A cure is not the only thing that is worth hoping for; without taking away hope, specialists can provide an accurate prognostic awareness to their patients, which might involve redirecting hope so that it’s reasonable.

The last myth is that oncologists can and should do all of the palliative care themselves. To assume that the clinical benefits seen in studies would be generalizable to primary palliative care fails to recognize a couple of key differences, according to Lefkowits. The biggest one is time. The average first palliative care visit is typically 1 hour, and there’s just not enough time for this in the oncology clinic during a visit.