Physician: Palliative Care Growth Requires Philosophical Changes

To ensure growth of palliative care availability and utilization, the health care system must help improve patients’ understanding of what palliative care actually is. Key to achieving this is a change of perspective on how clinicians, patients and families perceive treatment of serious illness, according to Adil Akhtar, M.D., an oncologist for the physician practice Michigan Healthcare Professionals.

Clinicians should take a holistic approach toward treating serious illness, particularly cancer, in which the well being of the patient’s entire body is considered rather than the individual organs or biological systems directly affected by their disease, Akhtar said in a Journal of Clinical Pathways podcast. Amelioration of symptoms through palliative care would be a key component of this approach.

“We need to change the whole philosophical discussion. I am going to give you an example of cancer treatments. Once someone is diagnosed with cancer, then we as a system and as a society tell them to fight it, to start a war. In effect, treatment of cancer is really not treatment at all. It is a fight. It is a war,” Akhtar said. “Then, while we fight the war, we get so focused and consumed on just a small part of the patient’s body that we start to ignore the rest of the body. In my opinion, this whole discussion needs to shift from starting a war to taking care of the patients holistically. You take care of the cancers, and you also take care of the entire patient.”


Akhtar practices medicine at Michigan Healthcare Professionals. In 2017 the organization committed to improving it’s palliative care programs within its oncology division, beginning with the founding of a palliative care and end-of-life care subcommittee — a team of physician specialists who serve as champions for those times of care.

The team in 2017 launched an awareness and education program to educate both clinicians and patients and families about the nature and merits of palliative care and hospice.

“When we started the program, we looked at where the holes are. We know that in our health system there are good inpatient palliative care programs. Where we were missing was in the community. What we did is create a community‑based program. The uniqueness of our program is that it is a nurse practitioner run and is physician‑led program,” Akhtar said in the podcast. “We have a multidisciplinary team which takes these patients at home and in the nursing homes. Then, we coordinate the care with the primary oncologist and our multidisciplinary team.”


Lack of awareness is a major barrier to palliative care expansion. A Journal of Palliative Medicine study, published in April, found that as many as 71% of people in the United States have little to no understanding of what palliative care is, including many clinicians in a position to refer patients to palliative care or hospice.

Close to 60% of patients who would benefit from palliative care do not receive those services, despite the availability of community-based palliative care as well as hospital-based palliative care, according to a recent report from the New England Journal of Medicine Catalyst Insights Council.

Home-based palliative care could reduce societal health care costs by $103 billion within the next 20 years, the nonprofit economic research group Florida TaxWatch said in a report. Palliative care in general can reduce health care costs by more than $4,000 per patient, according to a July 2017 study in Health Affairs. It can also reduce the frequency of 911 calls, emergency department visits, and unnecessary hospitalizations.

Akhtar is not alone in calling for a shift in philosophical perspective. Speaking in a panel at the National Association for Home Care & Hospice Financial Management Conference in Chicago in July, Bruce Greenstein, vice president of innovation for LHC Group (NASDAQ: LHCG), told the crowd that, “rather than focusing our energy on carving hospice into Medicare Advantage, we should be focusing our energy on changing the sociology of death so patients and families can benefit from hospice care sooner.” 

Hospice physician B.J. Miller voiced a similar perspective in a July interview with Hospice News.

“Our language gives us away. We have this old-fashioned notion that life is a fight against death, as though death were a foreign invader instead of a natural thing that is completely entwined with life,” Miller said. “We talk about death as a failure … So we find all these exotic ways to keep the subject at a distance, and in daily life it has become easier and easier to become distracted from this. And it means that so many people wait way too long to elect hospice. And if they do enter hospice at all, it’s often in the final days where there is not much time to do all that we can to bring life to a close and provide some comfort.”

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