A Personal Perspective on Palliative CareOct 24, 2018 06:00AM ● By Med Magazine
By Alex Strauss
This summer, Thomas Asfeldt, RN, BAN, MBA, Director of Outpatient Cancer Services at Sanford USD Medical Center, lost his 87-year-old father-in-law to metastatic lung cancer. The Wallace, South Dakota area farmer had been a life-long non-smoker and the unexpected diagnosis this past May hit the family hard.
“He had extensive disease burden which really limited his options,” says Asfeldt. After considering all of the possible therapeutic routes, including targeted therapies and clinical trials, it was decided that the only viable treatment was chemotherapy — and that was not an attractive prospect.
“In conversation with his oncologist, we determined that it would probably not give him more than about a month of extra life,” says Asfeldt.
So the family decided to meet with Sanford’s palliative care team, experts devoted to preserving quality of life by managing symptoms during, after, or — as in Asfeldt’s father-in-law’s case — instead of treatment.
“The palliative care team really helped us clarify what his goals were for the last months of his life,” says Asfeldt. “It became clear that another month of life didn’t mean anything to him if he had to spend it tired or tied to chemotherapy sessions.”
Instead, what Norris really wanted was to spend those last months on his farm, in as little pain as possible, visiting with his children and grandchildren, and maybe even driving his tractor a few more times.
“So his ‘treatment’ was to opt for palliation and just let the cancer take its course,” says Asfeldt. “It was the palliative care team that helped us make those decisions and get us on the right trajectory to manage as the disease progressed.”
Asfeldt has been around palliative medicine in his position at Sanford for more than 13 years, but he says it wasn’t until he went through this deeply personal family experience that he truly understood the value of this underutilized approach to supportive care.
“Going forward I’m definitely going to be more assertive about encouraging other team members to engage the palliative medicine team early for the benefit of the patient,” says Asfeldt. “We don’t always do that so well in medicine. We tend to continue to treat the patient aggressively, forgetting that the palliative medicine team can help us along the way while we’re treating the patient.”
Asfeldt points to research demonstrating the ability of palliative medicine to simultaneously improve quality of life while reducing the cost of care, not only at the end of life, but also during active treatment. “Palliative medicine and active treatment often go hand-in-hand,” he says. “The two are not mutually exclusive.”
As a long-time volunteer for the American Cancer Society, Asfeldt has been a long-time advocate of the proposed Palliative Care and Hospice Education and Training Act (Senate Bill 693), a national initiative to bolster understanding, access, and utilization of palliative medicine which has wide bipartisan support.
“The idea is to enable physicians, nurses and other members of the healthcare team be advocates for using palliative medicine like my family did,” says Asfeldt. “It improves quality of life and decreases the cost of care. Why would we not want to use it whenever we can for every appropriate patient?”
Learn more about the Palliative Care and Hospice Education and Training Act