The term “personalized medicine” is often used to describe health needs based on a patient’s genetics. However, more stakeholders are applying the term to hospice and palliative care.

Personalized medicine is a step away from a “one-size-fits-all” approach to health care. The model uses information gathered from a patient’s genome to plan for care, treatment and services, and to some extent, predict a likely health trajectory, according to the National Human Genome Research Institute, part of the National Institutes of Health.

However, the concept of personalized medicine, also known as precision medicine, can extend beyond the realm of genetics, according to Dr. Howard McCleod, medical director for precision medicine and professor of medicine and biology at Utah Tech University.

“I take it beyond genetics. I look at it as using individual patient attributes to guide their care. And so it could be genomics, certainly, that’s very personal,” McCleod told Hospice News. “Certainly we already use body weight and drug interactions and organ function and what the co-pay is — all sorts of features that are linked with the person that we use as ways of guiding our choices for therapy.”

While genetic information can be useful in hospice and palliative care, patients rarely have that data.

Between 2012 and 2019, only 6.8% of 1.3 million cancer patients had germline DNA testing done. The testing was highest in men with breast cancer, 50% of whom underwent genetic testing, according to a 2023 study.

One of the authors of that study, Dr. Joann Bodurtha is a professor of genetic medicine, pediatrics, and oncology at the Johns Hopkins University School of Medicine, told Hospice News that taking a detailed family health history can be an important first step in assessing and predicting patients’ needs.

“We know that family history concerns can be an important part of goals of care in significant illness and have meaningful use,” Bodurtha said.

Goals-of-care conversations also play an important role. Personalized medicine begins with those conversations, according to McCleod. Understanding a patients’ goals and wishes is essential to tailoring care to their specific needs, he said.

Another factor is timely admission to hospice. If a patient is enrolled hours or a few days prior to death, little time exists to truly understand their individualized needs and determine a course of action. Whereas if hospice were a planned event, patients could receive additional tests prior to entering the benefit that could guide their care. It also allows more time for hospice clinicians to assess the patient and understand their goals, McCleod said.

“There’s a lot of medicine that is practiced in a ‘recipe book’ sort of fashion. We all know some chefs that follow the recipe to the individual ounce, and then others that wing it and make their own version of things. And we see both of those in medicine,” McCleod said. “We can know things about a person prior to prescribing that will allow us to do better than a coin flip. In the context of hospice, it is especially important, because you don’t really want to do trial and error with something like pain control or even nausea.”