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The Daily Wildcat

The Daily Wildcat


    Approach to palliative care differs culturally


    Courtesy of Benjamin Horn 

    Benjamin Horn recorded palliative care discussions between patients and physicians in the thoracic cancer unit in Germany. Horn found palliative care consultations in Germany to be more personal than consultations in the U.S. 

    As the U.S. population ages, palliative medicine and care is continuing to grow and become a bigger part of medical professions. Benjamin Horn, a senior studying biology and German, carried out an investigation into the current state of this field of medicine by comparing the U.S. to the burgeoning palliative care medical specialty in Germany.

    “Palliative medicine is a medical subspecialty with a focus on relieving suffering and improving quality of life for people of any age, and at any stage, in a serious illness — whether the illness is curable, chronic, or life-threatening,” said Dr. Mindy Fain, a professor of medicine; division chief of geriatrics, general internal medicine and palliative medicine in the College of Medicine — Tucson; and co-director of the Arizona Center on Aging.

    In the current U.S. healthcare system, older patients are a rapidly growing group — about 10 percent of the population — which accounts for approximately 60 percent of overall costs, mainly due to unnecessary utilization, Fain explained.

    Horn conducted his research at the UA and Universität Heidelberg in Germany.

    “Cancer has been a big part of my life as [my family has] lost countless friends and family members,” Horn said. “My passion for cancer research and [palliative care] has grown with my interest for my German heritage.”

    Germany is a relatively interesting case with regard to palliative care research and funding since it was first introduced in Germany in 1993, Horn explained. While palliative care research was recognized in the U.S. in the 1980s, the topic was first introduced in the 1960s, he added. Horn said he wanted to compare the development of palliative medicine and care in each country, given the discrepancy in when the fields were recognized in each country.

    “My overall take-home message [from my findings] is the impact of direct, personalized care [on the patient],” Horn said. “In Germany, I found consultations to be longer [and more personal], which produced strong interpersonal relationships that were important for continued care as prognoses progressed.”

    As palliative medicine continues to develop as a field in the U.S., Fain explained that medical students and residents will need increased training, and the entire “team” dedicated to providing this form of care will also need to increase in size.

    “Palliative medicine requires that we step back and see our role as ‘cure sometimes, comfort always,’ and to take care of the whole person with deep attention to their goals and values and preferences,” Fain said.

    Much of Fain’s research focuses on providing lower cost with increased quality in home-based care, because individuals needing palliative receive fragmented care in a pre-existing system not designed to treat that group of patients.

    “All health care providers need to have the skills to provide palliative care as a part of their daily work and not as a ‘carve-out,’” Fain said.

    Palliative medicine is more than a consult service delivered to hospitalized patients by a dedicated service, she said.

    “[These studies] are important … because there exists a stigma on death,” Horn said. “By [conducting] qualitative and quantitative studies, … we can remove this stigma of death and create a healthy, open environment whereby patients, family members and the medical team can openly discuss and plan advanced directives.”


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