“The take home message of this study is NOT that primary palliative care does not work.”  So says Yael Schenker of the negative study of an oncology nurse-led primary palliative care intervention for people with advanced cancer.

And we pushed Yael and Bob Arnold (senior author) on this point - we have several negative studies of primary palliative care (see links below to podcasts)  - is it time to start to question the effectiveness of primary palliative care? 

We certainly all agree on the problem: we have only enough palliative care specialists to care for some small proportion of the population of people with serious illness.  But when we move away from specialist palliative care to primary palliative care do we lose something critical? Perhaps we cannot train primary providers (front line nurses and doctors generally) to deliver palliative care that is “good enough” to impact outcomes.

That’s one interpretation.  Another is that we need a “stronger dose” of primary palliative care.  In Yael and Bob’s study nurses averaged 2.2 visits, hardly robust longitudinal palliative care.  Patients who had 3 visits had better outcomes.

Unpacking negative studies is just as interesting as unpacking positive studies.  Knowing what doesn’t work is just as important as knowing what does.

Links:

• Negative multi-national study of primary palliative care in nursing homes
• Negative ICU primary palliative care intervention
• Project ENABLE
• Podcast on palliative care’s diversity problem
• Systematic review of palliative care