More on Palliative v. Disease Mgmt

Brad Flansbaum with a helpful suggestion in the comments to yesterday's post asking what is the difference between palliative care and disease management?

Brad says:

• 1) Dx Mgt: Organ based (CHF), infection based (AIDS, Hepatitis C), system based (Lupus)

• 2) Palliative care: "globally" based, not focused on specific diagnostic disease based criteria.

Anyone can meet the defined needs of palliative care, but not the reverse with dx mgt.

For example: folks with CHF can meet palliative care criteria (general application of SF-36, ADLs, depression scale, pain scale), but not the reverse, ie, NYHA or ACC criteria for heart function.

I find the notion that anyone could need palliative care (help focusing on goals of care, alleviation of symptoms) but not all persons needing palliative care would fit into a disease management paradigm to be helpful. I think that someone with CHF and being cared for under a CHF disease management program would likely be able to benefit from palliative care, but I think you could imagine someone being cared for under some disease management protocol not needing palliative care (high cholesterol for example).

From a research standpoint there is a need for more clarity in what is encompassed in a palliative care intervention, especially when thinking about external validity and how/whether you can replicate, and roll out the results in multiple locations.