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.
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:
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?
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.
As with the competing coverage, we’ll rule this one not applicable since the harms of palliative care are thought to be minimal.
This story deserves praise on a number of fronts:
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.
No disease-mongering here.
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.
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.
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.
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.
This story was not based on a press release.