Skip to main content

What is your front desk saying about palliative care?









by: Alex Smith, @AlexSmithMD


Do you know what the operator or person at the front desk is saying about palliative care?  When people call, saying the want palliative care, how are they responding?


A study being presented in abstract form at the palliative care and oncology research symposium addresses this simple but critical question. 


Researchers at Duke (Kathryn Hutchins, 3rd year medical student first author, Arif Kamal, oncopal researcher, senior author) cold called 40 major comprehensive cancer centers.  They used a "mystery shopper" approach.  They pretended to be a family member of a recently diagnosed inoperable liver cancer patient asking about palliative care services.  All 40 major comprehensive cancer centers report having palliative care services.  Here's what they found:
  • When asked straight up if they offer palliative care services, 10% gave an answer other than yes, including palliative services are for the end-of-life only or being unsure of what the term "palliative" meant.
  • Less than half of all callers were told that all elements of palliative and support services they asked about were offered.
  • Where were they actually referred after a "yes" [we offer palliative care] response?  Callers were most commonly referred to patient navigation and genetic assessment services.
I love this study, because it's a "rubber meets the road" sort of study.  As in, the rubber meets the road when someone actually calls to get a palliative care appointment and can't.  I also love it because it was not funded.  And because it was led by a medical student, and should serve as an inspiration to medical students nationally about what can be accomplished with a limited budget, skills, and time.


After reading the abstract, I tried to argue with another palliative care doc that most people don't get referred to palliative care by calling up and asking for the service. They get a referral to palliative care from their oncologist.  His response was, "maybe they are tying to call, and you never find out about it."  Touché.


So I tried it out.  I called our hospital on my cell phone and asked if they have palliative care services. 


The operator said, "what?"  I asked again.  A long silence.  Then my phone dropped the call (wifi calling is not ready for prime time). 


So I called back apologized for the disconnect, and asked again, "do you have a palliative care service?"


The operator said, "Yes, we do.  We don't get many requests for that.  Let me look it up.  OK, here it is, I'll connect you."


The phone rang.  It went to voicemail.


"Hi this is Caitlin Willham, I'm not in the office, please leave a message."


That's funny, because Caitlin is a geriatrics fellow, her office is right next to mine, and she is not part of the palliative care team.


Ooops.


Do you know what your front desk is saying about palliative care?  Call them.  You might be surprised.

Comments

Gregg V said…
A patient in a nearby large academic medical center was referred to palliative care while preparing for a bone marrow transplant, with high hopes for long-term survival following the BMT. His family was stunned when they called the hospital switchboard, asked for palliative care, the operator didn't know what it was, but after looking up the consultant physician said, "Oh, you mean the end-of-life service!" Oy! Thanks, Alex, for another excellent post, and Arif et al for an innovative and important study.
Alex Smith said…
Oy indeed Gregg, thanks for the comment.
Alex
Rafael R. said…
I think the front office frequently reflects the overall tone of an organization. When my father was diagnosed with mesothelioma, I asked if we should consider bringing in palliative care. The response from his oncologist and geriatrician was an emphatic, "Oh,no! He is certainly not ready for that!" With clinicians setting such an example, I would not expect much from the receptionist. It is more troubling when you encounter issues from an organization that has a good palliative care service, like the SFVA!
Betsy Barton said…
This comment has been removed by a blog administrator.
Alex Smith said…
HI Rafael and Betsy, thank you for your stories. Your right that we can't expect our operators to understand that palliative care is not restricted to imminently dying patients when our oncologists continue to send the same message. Hopefully the operators do not carry the same legacy and history of baggage as oncologists that needs to be undone to make positive change in understanding of palliative care.
Toni Glover said…
At our academic medical center, only physicians can initiate a palliative care consult, thereby imposing a gate-keeper effect on who can receive palliative care. Many physicians utilize palliative care consults as the bridge to hospice care, which adds to the confusion about what palliative care is.

Popular posts from this blog

Geroscience and it's Impact on the Human Healthspan: A podcast with John Newman

Ok, I'll admit it. When I hear the phrase "the biology of aging" I'm mentally preparing myself to only understand about 5% of what the presenter is going to talk about (that's on a good day).  While I have words like telomeres, sirtuins, or senolytics memorized for the boards, I've never been able to see how this applies to my clinical practice as it always feels so theoretical.  Well, today that changed for me thanks to our podcast interview with John Newman, a "geroscientist" and geriatrician here at UCSF and at the Buck Institute for Research on Aging.

In this podcast, John breaks down what geroscience is and how it impacts how we think about many age-related conditions and diseases. For example, rather than thinking about multimorbidity as the random collection of multiple different clinical problems, we can see it as an expression of the fundamental mechanisms of aging. This means, that rather than treating individuals diseases, targeting …

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…