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Palliative Care Extends Life, Study Finds

Rating

4 Star

Palliative Care Extends Life, Study Finds

Our Review Summary

Our reviewers were split on one distinctive feature of this story – the discussion of the health care reform bill brought Glenn Beck and Sarah Palin into the story. One reviewer thought that had an uncertain effect and that the space could have been better used to provide more practical information about costs, benefits, and the limitations of this particular study.   The other two reviewers felt it was an appropriate and laudable editorial decision – that because the field of palliative care has been haunted by the "death panel" rhetoric of last summer, bringing it to the forefront in this story confronts directly one of the issues that prevent people from accessing palliative care, even when it is available — concern about palliative care hastening death.

We appreciate that the Times’s foray into this issue added some nuance that was missing in other coverage. The Times coverage also is notable for offering the most accessible description of what palliative care actually means, including practical examples of the services and treatment provided to patients. The competing coverage often relied on jargon about "psychosocial support" and other vague terminology that will likely be meaningless to many readers.  

 

Why This Matters

We can’t know if palliative care is a good thing if we don’t know what it means. The Times description is good enough to be quoted at length:

"Palliative care typically begins with a long conversation about what the patient with a terminal diagnosis wants out of his remaining life. It includes the options any oncologist addresses: surgery, chemotherapy and radiation and their side effects. But it also includes how much suffering a patient wishes to bear, effects on the family, and legal, insurance and religious issues. Teams focus on controlling pain, nausea, swelling, shortness of breath and other side effects; they also address patients’ worries and make sure they have help with making meals, dressing and bathing when not hospitalized."

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Although it touches on reimbursement, this story never addresses the key issues that most readers will be interested in — how much do palliative care consultations typically cost, does insurance cover it, and does this approach stand to increase or decrease the overall cost burden on our health care system?

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

Like the competing coverage, this story featured prominent discussion of the survival benefit associated with palliative care. We were pleased to see that it also spent some time on the improvement in quality of life and depression scores as well as the reduction in aggressive chemotherapy usage toward the end of life in the palliative care group. We wish the story had been more precise in its quantification of some the benefits — it notes that the palliative care group reported "less depression" and "happier lives" but offers no way to judge the magnitude of the benefit. However, we don’t think these shortcomings were enough to throw the story out of balance.

Does the story adequately explain/quantify the harms of the intervention?

Not Applicable

As with the competing coverage, we’ll rule this one not applicable since the harms of palliative care are thought to be minimal.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

This story deserves praise on a number of fronts:

  • It provided an excellent account of the experiment, including discussion of its design, number of patients, outcomes, and length of follow-up.
  • It provided a practical, plain-language definition of palliative care that avoided the vague jargon prevalent in the other write-ups.
  • Its analysis of the findings was extensive and compelling — it gave reasonable explanations for why palliative care might prolong life while making sure to emphasize that the study couldn’t determine which theory was right.

On the downside, there was no cautionary language at all about the limitations of this study. The WSJ, by contrast, explained that the study was conducted at a single site and couldn’t be blinded. It also noted that patients in the palliative care arm got more overall attention from caregivers, which might have affected the results. 

A close call, but since the evidence always has limitations, we think it’s an important journalistic best practice to always provide some kind of comment about those limitations. This story didn’t meet that standard.

Does the story commit disease-mongering?

Satisfactory

No disease-mongering here.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

A strong effort here. The story quotes one of the study authors, an independent editorialist, a physician-writer knowledgeable about end-of-life care, as well as leaders of professional groups that support hospice and palliative care. 

Does the story compare the new approach with existing alternatives?

Satisfactory

As noted in the competing reviews, the point of the study was to compare early palliative care with existing standard cancer treatment. However, this story, like the others, could have provided more information about what standard cancer treatment — the current "existing alternative" — entails. 

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

Mixed bag here. The Times noted that Medicare pays for some palliative care services but that billing difficulties may deter physicians from offering it. However, there was no mention of the difficulty patients may have accessing the type of outpatient palliative care services that were offered in this study. Most non-hospice palliative care is currently provided only in the inpatient / acute care hospital setting. A borderline satisfactory.

Does the story establish the true novelty of the approach?

Satisfactory

By all accounts, this is the first randomized controlled study to show that providing palliative care early after a diagnosis of advanced cancer improves survival and other outcomes. The story accurately characterizes the significance of this.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This story was not based on a press release.

Total Score: 7 of 9 Satisfactory

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