Early Palliative Care in End-of-Life Care: Most Important Advantages
The most important advantage of early palliative care initiation in end-of-life care is improved quality of life, with evidence showing it not only reduces symptom burden but also extends survival in advanced cancer patients. 1, 2
Quality of Life Benefits
- Early palliative care significantly improves quality of life both in the short term (≤3 months) and long term (>3 months) compared to standard care alone 3
- Patients receiving early palliative care experience reduced physical and psychological symptom burden, with significant reduction in symptom intensity when treated for more than 3 months 3, 2
- The EIPC (Early Intervention with Palliative Care) trial demonstrated that early palliative care not only improved quality of life and reduced depressive symptoms but also extended median survival from 9 months to 12 months in patients with non-small cell lung cancer (P=0.02) 1, 2
Enhanced Patient Understanding and Decision-Making
- Early palliative care promotes better patient understanding of prognosis and treatment goals, enabling more informed decision-making about end-of-life care 2, 1
- Patients who receive early palliative care have enhanced prognostic awareness, which influences their care decisions and helps align treatment with their values and preferences 2, 4
- Early initiation allows patients to establish appropriate goals and expectations for anticancer therapy, shifting focus from prolonging life to maintaining quality when appropriate 1
Reduced Aggressive Care at End of Life
- Early palliative care is associated with less aggressive care at the end of life and increased use of hospice services 1
- Patients receiving early palliative care have a lower likelihood of receiving chemotherapy in the last 60 days of life (odds ratio 0.47; 95% CI, 0.23-0.99; P=0.05) 2
- Early palliative care reduces emergency department visits, hospitalizations, and ICU admissions near death 1, 5
Improved Advance Care Planning
- Timely initiation of advance care planning early in the disease course promotes delivery of care aligned with patients' wishes regarding treatment at end-of-life 1
- Early palliative care increases the likelihood that patients who prefer to die at home are able to do so 1
- Patients who die in intensive care units have higher levels of physical and emotional distress compared with patients dying at home or in hospice 1
Benefits for Caregivers
- Early palliative care reduces caregiver burden and improves caregiver satisfaction with communication 1, 4
- Caregivers of patients who die in intensive care units have a greater incidence of prolonged grief disorder compared to those whose loved ones die at home or in hospice 1
- Early palliative care strengthens relationships between patients and caregivers and provides enhanced meaning and personal growth during difficult times 1
Implementation Considerations
- Effective early palliative care includes a team approach for honest communication, clear description of diagnosis and treatment options, frank discussion of prognosis, and setting medically appropriate treatment goals 2, 1
- Despite demonstrated benefits, palliative care consultations are often provided too late in the disease course to achieve maximum benefit 1
- Common barriers to early palliative care include resistance by families (40.2%), concern that doctors are "giving up" (30.4%), and miscommunication regarding prognosis or diagnosis (27.4% and 16.2% respectively) 1
Pitfalls to Avoid
- Waiting until the "bitter end" when patients no longer have the energy, will, stamina, or capacity to seek closure 1
- Failing to reassess patients' treatment goals, expectations, and preferences for prognostic information as disease progresses 1
- Continuing anticancer therapy when the value diminishes and palliative therapy should be intensified 1
- Assuming palliative care is only for patients at the very end of life rather than an approach to improve quality of life throughout serious illness 1