Two bills currently before the 113th Congress call on lawmakers to recognize that the rapidly expanding and aging population of patients in the United States who are currently coping with serious illness demands that palliative care be provided as a function of clinical treatment, not just an off-ramp from treatment into hospice.1,2
If signed into law, the sister bills will summon a new era in oncology treatment in which clinical and palliative care are more closely blended together, and oncologists and students are trained from proven best practices to better communicate issues of palliative care to their patients, said Rebecca Kirch, Director of Quality of Life and Survivorship for the American Cancer Society (ACS) in Washington, DC.
The Patient Centered Quality Care for Life Act (H.R. 1666) is a strategic bill—with 90 cosponsors—designed to identify where more training and educational material is needed to create improvements in patient quality of life (QOL). Once identified, the bill will authorize funding for the required training and material for medical institutions.
The Palliative Care and Hospice Education and Training Act (H.R. 1339) is a more tactical bill designed to authorize the funding needed to jump-start the development of palliative care centers and hospice education centers, and ensure the effort prospers through awards, incentives, and grants. This bill has 116 cosponsors.
If passed by Congress and then signed by the President, the bills could become law this year, and would direct the Secretary of Health and Human Services (HHS) to do the following:
- Convene a Patient-Centered Health Care and Quality of Life Stakeholder Strategic Summit to see what is preventing broader exercise of “patient-centered health care that integrates symptom management and other aspects of coordinated or palliative care.” (H.R. 1666)
- Look for solutions to what is preventing this activity, which can be scaled to the size of the growing patient population. (H.R. 1666)
- Require the Centers for Disease Control and Prevention (CDC) to play a part in increasing the availability of “integrated and patient-centered care” for pain, symptoms, and QOL. (H.R. 1666)
- Work with the National Institutes of Health (NIH) to enact recommendations from HHS and the CDC. (H.R. 1666)
- Pay for the establishment or operation of palliative care and hospice education centers to “train health professionals in palliative care” as well as the retraining and continuing education of faculty in palliative care. (H.R. 1339)
- Provide students with clinical training in palliative care in long-term care facilities, home care, hospices, chronic and acute disease hospitals, and ambulatory care centers. (H.R. 1339)
- Help pay for the training of physicians who plan to teach palliative medicine. (H.R. 1339)
Say It Simple and Stop
The bills speak to the all-inclusive need for palliative care for all chronic illnesses; however, medicine learns the most about palliative care through the experiences of patients with cancer, so a good deal of the research used to draft the language of the bills was drawn from the ongoing pipeline of oncology-specific studies and cancer-related palliative care workshops sponsored by the ACS, said Ms. Kirch, who helped draft the language for H.R. 1339.
One of these workshops, Advanced Communication Skills for Difficult Situations (ACSDS), was presented in November 2013, and put 20 oncologists individually against actors trained to portray terminally ill patients with cancer. The goal was to build a “playbook” of best practices for oncologists to follow when discussing palliative care with patients, said Anthony Back, MD, a medical oncologist at Fred Hutchinson Cancer Research Center in Seattle, WA, who spearheaded the ACSDS workshops.