This week, Professor Scott Murray talks about his belief that early palliative care helps people live with – not die from – a serious illness. A recent medical scare of his own means Scott has been able to bring a very different, personal lens to his thinking about his professional area of expertise.
Scott tells us:
Two years ago I was told I had cancer. Although I’m a GP it was still a terrible shock and I was immediately busy in a helter-skelter of getting things diagnosed and the beginning of treatment. So although the emphasis was on getting treatment for the cancer, there was a lot of anxiety and questioning in my mind at that very early stage. And this is true for most of my patients with a new diagnosis of a life-threatening illness.
I got surgery and am cured (touch wood), but looking back I’m thinking it would have been really useful to have had a little psychological or emotional support at the time of diagnosis. This type of support is sometimes called “early palliative care” which is not about dying, morphine and fluffing up pillows, but about helping people live as well and as fully as possible despite a life-threatening illness. The trigger for it should be getting a life-threatening illness although nowadays most doctors and patients associate “palliative care” with dying with cancer. Such a shame.
I wrote a short personal view in the British Medical Journal calling for up-front psychological support for people with life-threatening illness much earlier than in the last days or weeks of life. I called the article “Setting a low bar for palliative care”.
Palliative care helps people live
If you get a serious illness or know a friend who’s ill, please ask them to request early support and information to cope with the uncertain future. Facing up to the possibility of dying is helpful. For those who die, evidence shows that planning makes it 6 times more likely for patients to get what they want. For those who survive, the experience of thinking about what really matters in life helps you see things clearer and enjoy life more. I can testify to that!
You can see that for people with cancer, social decline tends to follow the physical one.
The psychological and spiritual issues seem to get worse at 4 quite predictable times:
- around diagnosis
- getting home after treatment
- at recurrence of a cancer
- in the last few days.
This is a common pattern and may be useful to know about so you know what might lie ahead. It’s always good to hope for the best, but have a plan B.
Professor Scott A Murray is St Columba’s Hospice Chair of Primary Palliative Care, Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh. He’s part of the International Primary Palliative Care Network and involved with SPICT.
Get a plan B
Find out how to have a good death.
Read more about the benefits of planning for the end.
Understand what you can do about healthcare planning.
Find out about legal and financial planning to make sure your affairs are in order.
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