Thursday, March 15, 2007

Lecture on End-of-Life Care for Minorities

An article entitled "Pain relief expert to speak on inequalities in late-life care", by Gary Rotstein, published March 14, 2007, in the Pittsburgh Post-Gazette, noted an upcoming lecture to be delivered by nationally-recognized medical expert Dr. Richard Payne, who now serves as the Director of Duke University's "Institute on Care at the End of Life".

The lecture will focus on disparities in late-life treatment of racial and ethnic minorities compared to other groups.

It will be held at the Hillman Cancer Center, (affiliated with the University of Pittsburgh Cancer Institute, of the University of Pittsburgh Medical Center), beginning at 5 p.m. on Monday, March 19, 2007.

Dr. Richard Payne is recognized as an African-American "History Maker". His biography indicates that he is one of the foremost experts on pain management and palliative care in the country.

He describes palliative care as total care of patients with cancer.

He has worked tirelessly to educate the medical community about the issues and breakthroughs in pain management, co-chairing the expert panel of the Agency for Health Care Policy that established clinical guidelines for pain management in cancer patients.

Payne was also a member of the Institute of Medicine Committee that evaluated end-of-life care in the United States.

He founded the Initiative to Improve Palliative Care for African-Americans, which promotes research, education and policies to improve care for African American patients facing serious illness. He also has been involved with the Open Society Institute and its Project on Death in America.

He also led the
Memorial Sloan-Kettering's Pain and Palliative Care Service, a multidisciplinary program dedicated to providing the most advanced methods of cancer pain assessment and management.

Such palliative care treatment has the following characteristics:
  • Affirms life and regards death as a normal process.
  • Neither hastens nor postpones death.
  • Provides relief from pain and other distressing symptoms.
  • Integrates the psychological and spiritual aspects of patient care.
  • Offers a support system to help patients live as actively as possible until death.
  • Offers a support system to help the family cope during the patient's illness and in their bereavement.
In an article that reported on a lecture he delivered in May, 2004, about developments in palliative care treatment, Dr. Payne was referenced as a "Great Teacher", and his message was repeated. See: "Payne Examines End-Of-Life Issues at Grand Rounds", by Carla Garnett, published in the May 11, 2004 issue of the NIH Record, by the National Institutes of Health.

That article concluded:

In the past few years, Payne said, experience and thoughtful discourse in the emerging end-of-life field has highlighted the importance of many concepts, including the necessity of assembling a multidisciplinary team for every patient that includes not only physicians and nurses, but also skilled social workers, clergy and other counselors.

Still, he pointed out, the territory remains unfamiliar, the footing often unsure for those in medicine. Effective palliative care is relatively new, even though terminal illness is not.

"We have a saying, 'Pain is the oldest human problem, but probably the youngest medical specialty,'" Payne offered at the start of his lecture.

"I think we're in the middle of a real renaissance and a real interesting rebirth of how we are thinking about fundamental things like pain, how we evaluate subjective effects in individuals and how we approach and alleviate human suffering."

Dr. Payne posts a welcome message on the website of the Duke Institute on Care at the End of Life.

The Institute, born in 2000, has a bright future. We have facilitated and conducted important conversations with diverse religious, spiritual, patient and advocacy communities concerned about access to and quality of palliative and end-of-life care. Our trademark interdisciplinary educational conferences include: Crossing Over Jordan © and the Last Miles of the Way Home © for African-American and other communities of color; Magnified and Sanctified © for Jewish communities, and Suffer the Children © for children who are seriously ill or dying.

In the past five years many exciting developments have occurred in palliative and end-of life-care. The use of hospice services by Americans continues to increase, with nearly one million patients and families using hospice care in 2004, an all time high. Hospital-based palliative care teams continue to grow, expanding basic care to focus on emotional and spiritual well being while simultaneously providing the best that state-of-the-art curative medical treatments can offer.

As an African-American, Dr. Payne is particularly well-qualified to teach about the disparities in end-of-life care -- including palliative care -- experienced by black Americans and by other racial minorities.

This disparity was highlighted earlier this week in a widely-noted article published in the Washington Post, entitled
"At the End of Life, a Racial Divide: Minorities Are More Likely to Want Aggressive Care, Studies Show", by Rob Stein (Page A01, 03/12/07).

The article quoted Dr. Payne as an authoritative source:

After lives in which they often struggle to get medical care, African Americans and other minorities are more likely than whites to want, and get, more aggressive care as death nears and are less likely to use hospice and palliative-care services to ease their suffering, according to a large body of research and leading experts.

As a result, they are more likely to experience more medicalized deaths, dying more frequently in the hospital, in pain, on ventilators and with feeding tubes -- often after being resuscitated or getting extra rounds of chemotherapy, dialysis or other care, studies show.

"I think we need to be very attentive to attending to suffering in our patients and do everything we can to help minimize and ameliorate it," said Richard Payne, who runs Duke University's Institute on Care at the End of Life. "African Americans and other minorities are at greater risk of not dying well."

Those who attend his lecture in Pittsburgh next Monday evening will be privileged to hear from someone who knows & cares about these problems, and who offers some suggestions for improvement.

The presentation is free & open to the public.

“Self discipline is the highest form of self-respect.”
-- Dr. Richard Payne

* * *

Update: 03/16/07:

On March 16, 2007, a study report was published in Los Angeles, which addresses such issues of end-of-life care for various cultural groups in California.
See: "Californians’ End-of-Life Care Differs by Race and Ethnicity -- California HealthCare Foundation to Explore Ways to Improve EOL Care, Address Disparities".

Here's an excerpt (in which I added links):

In California, the most populous and diverse state in the country, significant racial and ethnic differences exist at the end of life, according to several reports commissioned by the California HealthCare Foundation. These reports -- the first in a new series of CHCF-supported projects focusing on end-of-life issues -- found significant variations in the expectations, experiences, and decisions of patients and their families in the months preceding death.

As Californias diverse population grows older, ensuring quality care at the end of life for everyone takes on even greater significance, Mark D. Smith, M.D., M.B.A., president and chief executive of CHCF, said Thursday at the Association of Health Care Journalists conference in Los Angeles.

By supporting research and projects to improve the quality of end-of-life care, CHCF sees an opportunity to help make California a national example of best medical practices and culturally appropriate care.

One report released today, Racial, Cultural, and Ethnic Factors Affecting the Quality of End-of-Life Care in California, reviews and analyzes current data, along with new research from focus groups and surveys. The report examines the causes and patterns of death and dying and the impact on the delivery of health care.

Focusing on patterns across populations can reveal information about access and disparities and is useful for policymakers thinking about improving the health care system, said LaVera Crawley, M.D., M.P.H., a Stanford University medical ethics researcher and lead author of the report. Clinical providers, on the other hand, should balance these racial, ethnic, and cultural factors with the preferences of each individual patient.

Document downloads (in PDF format) regarding this Report are available: