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The future of palliative care - Issue #31


The future of palliative care

June 3 · Issue #31 · View online

In many respects, we've arrived. Yet what we know now won't get us to the next level. So I'm looking for signals from the future, & I'm curating them here.

“My job is to be lowered like carbon rods into that radioactive sludge and absorb the radiation of the insanity that happened today.” Stephen Colbert

"I was the 'chemoboy'". Is that how we want future oncologists to see themselves?
"I was the 'chemoboy'". Is that how we want future oncologists to see themselves?
1. At ASCO, resident shaming is 'patient-centered'.
I’m in Chicago at the American Society of Clinical Oncology–the meeting opened yesterday with a patient story by a fellow, Edmond Ang MBBCh (video here; start at 8.38) describing his time as ‘chemoboy’, when attending had dressed him down in front of the entire team because a chemotherapy agent had been infused too quickly (although no patient harm occurred). After the attending left, the patient apologized to Ang, explaining that she was desperate to get back home. Although ‘humiliated’, Ang hears the patient’s voice for the first time. Lesson: being patient-centered entails humiliation. It’s an old trope–being patient-centered means bucking the system–and you’ll be punished. Ugh.
2. Medicaid expansion under the ACA improved access.
An analysis of 30,000 patients with advanced cancer comparing access for African American patients with cancer before and after ACA expansion (comparing states where this happened vs states with no Medicaid expansion) (abstract here) showed that “implementation of Medicaid expansions as part of the ACA differentially improved African American cancer patients’ receipt of timely treatment”. After ACA expansion, those states showed that “prior racial disparities were no longer observed after Medicaid expansion.” What this means for palliative care: governmental payment models are powerful means for ensuring access. Also notable: the study was performed by a non-academic, non-governmental, for-profit company, Flatiron Health, that has access to 2.2 million patient records. Interesting.
2019 ASCO: Medicaid Expansion and Time to Treatment in African American Patients Compared to White Patients With Cancer - The ASCO Post
3. "Dying as one wishes has become a luxury."
“Death positivity” has reached the tech-savvy pages of Fast Company: “America, a country founded on rugged individualism and freedom, can’t accommodate even the simplest of last choices.” This is not a fluke: Vox noted earlier this month that “the way we die now will be considered unthinkable 50 years from now.” It’s a ‘global wellness trend’ that according to new consumer research, spans many age groups. But simple? Could dinner parties and death doulas overcome our current collision course with biotech silver bullets and Silicon Valley’s quest to live forever? The full report is worth a read, and will protect you from FOMO: after all, the Stoics are ‘trending.’
“I refuse to have a terrible death”: the rise of the death wellness movement
4. Long term care is our climate change.
There are 78 million baby boomers who are aging into a society where family caregivers are scarcer and paid care is becoming the norm. The problem: in a decade, most seniors won’t be able to afford the care, either at home or in a residence (read: nursing home). The early signals of this issue are not just in personal bankruptcies, but in the increasing suicides by seniors in long term care. Lacking a meaningful alternative to living at home, seniors are taking matters into their own hands. The Kaiser Health News story is full of poignant, horrible details: “An 82-year-old former aircraft mechanic, who had a history of suicidal ideation, suffocated himself with a plastic bag in a Connecticut nursing home in 2015. The facility was fined $1,020.” Indeed.
Lethal Plans: When Seniors Turn To Suicide In Long-Term Care | Kaiser Health News
What the plenary looks like--me & 40,000 of my closest friends.
What the plenary looks like--me & 40,000 of my closest friends.
This newsletter is made possible by The John A. Hartford Foundation & the Cambia Health Foundation, but the recommendations, opinions, and views are mine alone.
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