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Geriatric assessment should be included into palliative care
Challenges to Implementing Palliative Care in China
Current Status of Palliative Care Among Ethnic Minorities
Current Status of Palliative Care in China
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Hong-Tao Wang, Doctor Department of Burn and Cutaneous Surgery Xi'jing Hospital, Fourth Military Medical University, Lian-Jun Lu and Da-Hai Hu
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wanght{at}fmmu.edu.cn Hong-Tao Wang, et al.
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Dear Editor, We read with great interest a paper discussing the current status of palliative care clinical implementation, education, and research [1]. This paper is very helpful for clinicians, nurses, and community health workers to practice palliative care in a proper way. Palliative care is somehow a contradictory issue in cancer care and research fields; there are actually no "golden standards" in this field. What we can do is try to integrate variable protocols and give out a relatively objective evaluation to guide palliative care. Different protocols were offered to aid proper palliative care for cancer patients. Besides the education, training, and research activities mentioned in the paper, we recommend that geriatric assessment should be included in the palliative care education and training programs so as to benefit cancer patients as much as possible. Populations in the United States of America [2], Japan [3], and China [4] are now aging and facing more threats from cancer. For those older patients who are attacked by cancer and might be suitable to enter a palliative care program in order to keep them free from too much suffering and to get much support for the best quality of life, it is always a hard task to make the palliative care decision. Since aged people are the highest risk population for cancer, comprehensive geriatric assessment may help in making palliative care decisions. Geriatric assessment integrates independent predictive capabilities, including an evaluation of functional status, comorbid medical conditions, cognitive function, psychological state, social support, nutritional status, and geriatric syndromes. They work together to predict the risk of morbidity and mortality in these older cancer patients. Such an integrated evaluation may be a nice tool in the palliative care field. Unfortunately, the fact is that this geriatric assessment is not commonly applied in the medical practice, especially for cancer patients. Thus, we highly recommend applying it to cancer patients' care, to educate healthcare personnel for cancer therapy. Best regards, Hong-Tao, Wang, MD, PhD (1) Da-Hai Hu, Professor, MD, PhD (1) Lian-Jun Lu, Professor, MD, PhD (2) 1. Department of Burn and Cutaneous Surgery, Xi'fjing Hospital, Fourth Military Medical University, Xi'fan 710032, PR China 2. Department of Otorhinolaryngology, Xi'fjing Hospital, Fourth Military Medical University, Xi'an 710032, PR China Correspondence: Lian-Jun Lu, Department of Otorhinolaryngology, Xi'fjing Hospital, Fourth Military Medical University, Xi'an 710032, PR China, e-mail: lulianj@fmmu.edu.cn and Da-Hai Hu, Department of Burn and Cutaneous Surgery, Xi'fjing Hospital, Fourth Military Medical University, Xi'fan 710032, PR China, e-mail: burns@fmmu.edu.cn 1. Grant M, Elk R, Ferrell B, Morrison RS, von Gunten CF. Current status of palliative care--clinical implementation, education, and research. CA Cancer J Clin. 2009;59:327-335. 2. Olshansky SJ, Goldman DP, Zheng Y, Rowe JW. Aging in America in the twenty-first century: demographic forecasts from the MacArthur Foundation Research Network on an Aging Society. Milbank Q. 2009;87:842- 862. 3. Kato R. Transition to an aging Japan: public pension, savings, and capital taxation. J Jpn Int Econ. 1998;12:204-231. 4. Arnsberger P, Fox P, Zhang X, Gui S. Population aging and the need for long term care: a comparison of the United States and the People's Republic of China. J Cross Cult Gerontol. 2000;15:207-227. |
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Yunyou Duan, doctor Dept of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China, Ning Zhou, Lijun Yuan
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duanyy{at}fmmu.edu.cn Yunyou Duan, et al.
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Dear Editor, Dr Marcia Grant in her recent review [1] described clearly the challenges to implementing palliative care in the United States, including issues from workforce deficiencies to changing models of health care delivery. Besides the challenges listed by the authors, in our opinion, lack of evidence on which diseases favor palliative care is the first hurdle restricting recommendation of palliative care both in China and the United States. With the development of many new drugs, especially the biological drugs, the cancer survival is largely prolonged. In contrast, there is no benefit from aggressive surgery or other chemotherapy for some advanced cancer patients. For these patients, palliative care should be the right choice. Currently, both the doctors and the patients have few experiences or little evidence for the decision-making. We believe that with the advent of new promising drugs and new research support, palliative care should be and would be applied to the right person widely. As we know, different countries have different cultures. In China, traditional culture might also be a challenge to implement palliative care. In China, it is the responsibility for sons and daughters to care for the parents. Undergoing palliative care and giving up therapy sometimes is confusing, especially because the ordinary person is not informed this is also an active treatment. When giving up, the sons and daughters would be considered as "unfilial." To avoid this pressure from the community, sons or daughters usually favor aggressive treatment even for advanced cancer patients. This is especially true in the remote countryside. On the other hand, in some hospitals, reduced income from the palliative care for the hospital is also the challenge for doctors to make a decision. Sincerely Yours,
References 1. Grant M, Elk R, Ferrell B, et al. Current status of palliative care--clinical implementation, education, and research. CA Cancer J Clin 2009;59:327-335. |
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Katie J Olson, Graduate student John F. Kennedy University
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kolson2{at}jfku.edu Katie J Olson
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Dear Editor, I greatly appreciated the recent article by Grant and colleagues about the changes in the field of palliative care [1]. By recognizing palliative care as a medical specialty, it is my hope that more people will have increased access to and receive high-quality end-of-life care. As a graduate student completing my doctorate in psychology in a program that values multicultural competency, I did want to remind health care providers of the importance of considering the patient’s cultural and ethnic preferences and beliefs when formulating an end-of-life treatment plan. Palliative care should not be provided in spite of culture; it should be provided with respect to culture. As long as they are not harmful to the patient, alternative treatments should be discussed, encouraged, and included in order to promote trust in the doctor/patient relationship. This does not mean that palliative care must include religious ceremonies or alternative treatments; it simply means that the identity of the patient should be allowed expression in all important areas as the end of life approaches. Suffering can be eased on psychological and emotional, as well as physical, levels. Considering the cultural preferences of patients is another step palliative care can take towards allowing patients to face the end of their lives with dignity and peace. Sincerely,
References 1. Grant M, Elk R, Ferrell B, et al. Current status of palliative care--clinical implementation, education, and research. CA Cancer J Clin 2009;59:327-335. |
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Chunyan Yao, PhD, MD Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing, China
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yao_yao24{at}yahoo.com Chunyan Yao, et al.
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Dear Editor, We read with interest the article by Grant and colleagues about "Current status of palliative care--clinical implementation, education, and research" [1], which helps us understand the importance of palliative care for cancer patients and older adults. The authors provided an outstanding summary of palliative care, including clinical implementation, education, and current research. It is reasonable to point out palliative care should be paid much attention to in China. Acceptance of palliative care as a recognized medical specialty provides a valuable resource for improvement of care. But the opportunities for clinicians to understand and apply appropriate palliative and end-of-life care to patients with serious and life-threatening cancers are not available in most of the developing countries, for example, China. With the fast aging of the Chinese population, the numbers of people with serious and life-threatening disease are expected to increase dramatically. The number of people older than age 60 years will be 4.4 hundred million by the year 2050 in China, and China will be the country which has the largest population of old people in the world. But, the disparities between high-income, low-income, and middle-income families greatly restrict the implementation of such quality palliative care in China. This situation is especially serious in most of the low-income families, which carry a heavy burden because there is not enough money put into palliative care. Moreover, the treatment is the most important thing for these families. However, the field of palliative care also includes nursing, social work, psychology, and nutrition [2]. The low-income families should pay more attention to the nursing, psychology, and nutrition of patients with serious and life-threatening cancers. The palliative care services may be implemented by family and public organization in China. With best regards, Chunyan Yao, MD, PhD
Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University, Chongqing, 400038, P. R. China Correspondence should be addressed to Southwest Hospital, the Third Military Medical University, Chongqing, China; Chunyan Yao (yao_yao24@yahoo.com) and Weiling Fu (weilingfu@yahoo.com). References 1. Grant M, Elk R, Ferrell B, et al. Current status of palliative care--clinical implementation, education, and research. CA Cancer J Clin 2009;59:327-335. 2. Ferrell B, Connor SR, Cordes A, et al. The National Agenda for Quality Palliative Care: The National Consensus Project and the National Quality Forum. J Pain Symptom Manag 2007;33(6):737-744. |
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