The story was marred, however, by a failure to discuss any limitations of the research or to properly quantify the benefits. In addition, its sourcing included only experts likely to hold a favorable view of palliative medicine.
We cannot tackle the health care crisis without looking at the costs of care at the end of life. Medicare spends about $50 billion dollars per year on care during the last two months of life.
Decreasing the suffering and improving the quality of life of people with advanced illness (lung cancer in this case) is an important goal in and of itself – and argues for the need to improve the quality of cancer care to address these issues.
While it could have been more detailed about the actual numbers involved, this story explained that the cost of palliative care is currently comprised primarily of fees for doctor visits. It could have noted that this is the only component of palliative care that is billable currently, and that other members of the interdisciplinary care team usually cannot bill, so the cost of their salaries/time is usually borne by the institution. This story is also the only one of the four we reviewed to directly explain that palliative care might reduce overall health care costs by reducing hospital stays, emergency treatments, and futile end-of-life care.
Far from ideal, but a borderline satisfactory in our view. None of the other stories we reviewed even came close to matching this.
Although the description of the survival benefit was accurate and other important outcomes were at least mentioned, the story provides relative — not absolute — differences in its reporting on depression scores. It notes that depression "was less than half as common in the palliative care group" compared with the standard care group. So to readers this could mean that depression was found in 2% vs. less than 1% of patients in the standard and palliative care groups — a trivial difference. As it turns out, depression was found in 38% of standard care patients vs. 16% of palliative care patients, which is a very robust finding. Providing the absolute numbers to readers would have allowed them to judge the importance of this finding for themselves.
As with the competing coverage, we’ll rule this one not applicable since the harms of palliative care are thought to be minimal.
On the positive side, this story did a good job of describing the experiment and its outcomes and explained that the study is "one of the best tests yet of palliative care" — which it is. However, this story, like much of the competing coverage, failed to make note of any limitations in the research. We especially think it should have challenged the assertion, made by an editorialist, that "palliative care should be a routine part of managing any serious illness." We think it’s a stretch to draw that conclusion considering the limited evidence we have to support it so far. Soliciting a comment from someone outside the field of palliative medicine (a point addressed below under "Sources") may have yielded a counterpoint to this argument.
No disease-mongering here.
The story included multiple interviews with investigators and other experts and satisfies the criterion. However, we should point out that all of these sources could be loosely described as boosters for this particular study or palliative medicine in general. Two of the experts are the current and former presidents of the American Academy of Hospice and Palliative Medicine–a professional group that obviously supports increased awareness and use of palliative care. The editorialists quoted are affiliated with the department of palliative medicine at a major medical center. This reporter clearly was not afraid to pick up the phone and talk to people–an instinct which we applaud. But we wish she had spoken to someone — an oncologist, surgeon or geriatrician outside of the palliative care field–more likely to provide a different, perhaps more cautious, perspective on the results.
As noted in the competing reviews, the point of the study was to compare early palliative care with existing standard cancer treatment. However, the story could have provided more detail on the existing alternative – "standard of care" oncology care – which many have thought to be "state of the art".
This story didn’t mention any of the barriers patients may face in obtaining access to palliative treatments–especially the specific type of care offered in this study. While there is a significant number of larger hospitals that offer inpatient palliative care consultation or services, many fewer offer outpatient palliative care services, which was the intervention in this study. Such an article may encourage cancer centers to initiate such services, but they do not often currently exist.
This story did a good job of describing the palliative care offered in this study and how it differed from "comfort care" offered in the last few months of life. It accurately portrayed the novelty of the research.
It is clear that this story didn’t rely on a press release.