Progress Fighting Disease
The rigorous application of the scientific method over the last 150 years led to the
development of new knowledge and technologies. These continue to develop at an ever-increasing
rate.
Changes in the values and structure of society accompanied this progress. The society
values productivity, youth, autonomy and independence. Improved communication and
transportation permits people to migrate far from their families yet still maintain
those relationships.
Since the introduction of the scientific method in the mid 1800's there has been a revolution
in medical practice, including:
- Improved sanitation
- New medications, including antibiotics
- New surgical procedures and better sterile technique
- Diagnostic tests (CT / MRI) and interventions
- Many new therapies
This progress in the ability to eradicate or control disease distracted the medical
community from the effort to relieve suffering.
Driving this revolution was the explicit hypothesis that, if the underlying pathophysiological
derangements were understood, the diseases that befall mankind could be cured and the distress
they bring would be eliminated. The implication of this hypothesis, if pursued to its logical
conclusion, is that "no one will suffer and no one will die."
As a result of the success fighting disease, our society frequently views death as the "enemy"
to be beaten at all costs. Medical culture regards the death of a patient as a personal failure
of the physician and the health care system. At the same time, the care of patients with the
most serious illnesses has moved to institutions. The consequence is a society that has an
unrealistic perception of death and dying as portrayed in media dramatizations of younger
people. They are unaware that 80% of deaths occur among the elderly and 80% of these deaths
are from chronic illness.
Modern treatment affects how we experience Illness Today
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CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
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Rationale
Select section:
Changing Illness Experience
Changing Expectations and Needs
Progressive Healthcare Response
Responding to the Opportunity
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Changing Illness Experience
Illness in the Past
Progress Fighting Disaese
Illness Today
Prolonged Illness Experience
Chronic Disease Process
Determining Prognosis
Cancer
Manifestations
Predicament
Prolonged End-of-life Experience
Sudden Unexpected Death
Predictable Decline
Slow Decline, Multiple Acute Crises
Death in the US
Leading Causes of Death
Setting of Death
Desired
Reality
Multiple Issues Cause Suffering
The Square of Care
Morbidity
Pain
Need for Assistance
Social, Financial Impact
Implications for Care
Variable Need for Care
Opportunities
For Patients
For Families
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Changing Expectations and Needs
Increased Consumer Autonomy
Picker Institute 8 Dimensions of Care
Goals, Not Problems, Drive Care
Shift to Goal-oriented Care
Expect Competence, Expertise
Expect Comprehensive Assessment
Expect Effective Communication
Expect Participation in Decision-making
Expect Timely, Continous, Coordinated Care Delivery
Expect Assistance with Caregiving
Caregiver Training, Support
Caregiver Financial Support
Alternate Settings of Care
Respite Relief
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Progressive Healthcare Response
Focus on Disease-modifying Therapy
Focus on Care of the Dying
Early Hospice
Modern Hospice Movement
Dame Cicely Saunders
Origins of "Palliative Care”
Evolution of Hospice, Palliative Care
In United Kingdom
In Canada
In United States
Convergent Evolution
Hospice, Palliative Care in US Today
Hospice Growth
Continued Unmet Opportunity
A Public Health Issue
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Responding to the Opportunity
Paradigm Shift in Thinking
Provide Concurrent Care
Consider Application to Those at Risk
Expand Services, Settings of Care
1º, 2º, 3º Model of Delivery
Expand Access to Expertise
Create Specialized Environments
Many Names, Same Focus of Care
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