Dr. Marta Van Beek presented information about palliative care for dermatologists. Palliative care is designed to enhance patients’ and families’ quality of life (QOL) while negotiating serious illness. Dermatologists should know about palliative care because they may see certain patient populations more frequently than any other healthcare provider.
Marta Van Beek, MD, MPH, executive medical director, University of Iowa Ambulatory Care Clinics; C. William Hanke Professor of Dermatologic Surgery; director, Division of Dermatologic Surgery and Cutaneous Oncology, Department of Dermatology
First, Van Beek described palliative care delivery. Palliative care is appropriate for patients with long-term physical, psychological, social or spiritual sequelae of serious illnesses or treatment. Van Beek emphasized that palliative care is about being on offense rather than defense, anticipating and responding to suffering before it occurs.
Palliative care can be delivered concurrently with any life-prolonging therapies at any stage of illness. It is distinct from hospice care, which is intended for patients with terminal illnesses who are expected to live ≤6 months. Patients on palliative care do not need to relinquish any treatments; on hospice care all attempts to cure the illness are stopped. Palliative care focuses on managing physical and psychosocial suffering and validating the burden of disease for caregivers and families in their cultural context. It facilitates conversations about goals of care and coordinates care across medical specialties.
Second, Van Beek provided an overview of models to integrate palliative care conversations into clinical practice. These conversations seek to build trust, acknowledge prognostic uncertainty, align complex treatment decisions with goals of care, and validate emotions.
Van Beek discussed whether it is helpful or harmful to perform multiple biopsies or imaging on a patient with dementia. She emphasized the importance of giving patients and their caregivers all the information to make their own decisions before leading them down a specific therapeutic pathway.
Finally, Van Beek emphasized that patients are best suited to making decisions that align with their values. Allowing patients to make treatment decisions enables better alignment with goals of care, clarity for the patient and their family, improved outcomes, and improved patient satisfaction.
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