Read Dr. Hanson's full post at UNC Health Care's blog.

Atul Gawande gets it right again.  An articulate surgeon at Harvard, who steps away from the operating room to distill big health care issues into common language, has offered his take on the emerging field of palliative care.

Why is a surgeon writing about palliative care?  Like many surgeons, he sees patients with serious illness wrestle with difficult choices while coping with the symptoms of their illness.  In the last century, remarkable advances in public health and medicine have given Americans, and citizens of similarly wealthy societies, the ability to live into old age.  We have gained many years of well-being, but sometimes these years are tinged with the complexities of living well with chronic and incurable illnesses.

Most of us will acquire a treatable but incurable disease many years before our deaths — heart disease, cancer, stroke, chronic lung disease and dementia.  Dr. Gawande’s storytelling captures the physician’s and patient’s need to make sense of treatment options – pressing for cure when cure is possible, treating to prolong life when the disease course can be modified, and optimizing symptom control and attention to quality of life when disease is more advanced.

Do patients and families welcome palliative care?  Faced with serious illness that cannot be cured, a majority of Americans prefer treatment to emphasize comfort, autonomy, dignity, and family support. Palliative care in hospitals now improves the quality of pain and symptom control, and supports patients and families as they move through difficult choices.  Palliative care improves family satisfaction with care, and reduces costs without shortening survival.  Hospice provides palliative care outside hospitals – in homes and long-term care sites, as well as in specialized hospice inpatient units.

When is palliative care appropriate?  Unlike hospice, which is focused on the final months of life, palliative care can be offered at any stage of illness.  Palliative care providers see patients who are facing a new diagnosis of serious illness, and patients who are days from death.  We often work in collaboration with physicians offering disease-specific treatments.  Symptom control and emotional support can help seriously ill patients through surgery, chemotherapy, and other challenging treatments.

How does palliative care fit into a major research and teaching institution like UNC Health Care?  The UNC Palliative Care Program is an interdisciplinary group leading initiatives in clinical care, research and education.  Last year we served over 400 patients in many parts of the health system – medical and surgical units, intensive care, the Emergency Department, the North Carolina Cancer Hospital and UNC’s cancer clinics.

As UNC Health Care responds to the changing needs of patients and families we serve, our Palliative Care and Hospice programs will strive to offer the highest quality palliative care.

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