October is Palliative Care Month. A date that is marked on the calendar to highlight the importance of caring for patients at the end of life, an area in which María Herrera specializes. In addition, he added studies in geriatrics and a master’s degree in bioethics to his training. Without leaving aside the humanitarian aspect, Herrera endeavored to demonstrate that palliative care is also a convenient hospital practice, even from an economic point of view.
Their research demonstrates that patients treated by PKUs (palliative care units) experienced a reduction in unnecessary medical interventions and medications, resulting in substantial savings in healthcare costs. Additionally, family members reported receiving better emotional support and clearer communication about their loved ones’ condition.
Herrera highlights the need to integrate these teams more widely into hospitals to optimize resources and offer more humanized care focused on the needs of the patient and their family.
One of the strengths of his thesis is the reduction in costs when UCPs are involved. What is the reason for this economic saving?
Thanks to this care, fewer unnecessary (or futile, as doctors tell us) tests are performed at the end of life. When patients are cared for by palliative teams, they avoid spending on certain medications that are no longer useful at this phase of the disease. This is a pretty significant reduction. Specifically, palliative care can save up to 50% of expenses per terminally ill patient. Additionally, these savings could mean that more professionals will be hired. In my hospital (Infanta Elena de Valdemoro, in Madrid) we went from two doctors to three.
You talk about family satisfaction. What were the factors most appreciated by family members of patients treated by UCP?
Above all, honesty. They greatly appreciate knowing where the patient is in their illness and in their life. What they appreciate most is that expectations were matched to what was actually happening. They were able to say goodbye, close outstanding issues and fulfill their final wishes. In fact, what bothers the families of those who were not cared for in this way the most is that they did not know that their loved ones were going to die.
How to involve the patient and their family in end-of-life decision-making?
Always with the truth in front of you. We explain to them where they are and what we can do for them. This is what we call “person-centered medicine.” We don’t just see a patient with a prostate tumor or metastases, but a person who has to close the company’s problems, teach them to his colleagues, say goodbye to his teenagers… We have to integrate all this to illness. and see what the patient’s concerns are. We organize the last admission according to the patient’s wishes, as far as possible: “today I want to say goodbye to my children, I want my partner to come and finish teaching him or I want a psychologist to come and teach me help tell my parents that I’m going to die….’ We take care of everything that happens around its end, in addition, of course, to pain and other needs.
Do you remember an experience in which support made a significant difference in the patient’s quality of life?
An ALS patient wanted his organs donated and for his children to be told that “Daddy’s” organs would give life to other patients. The little children understood him very well and this helped his wife and children to experience much more bearable grief and to be proud of their father.
In Spain, access to palliative care is still unequal. From your point of view, what are the main obstacles preventing more equitable access to these services?
The problem is that I believe there is a lack of knowledge about what palliative care is and, of course, a lack of investment. Half of the population is not covered and some autonomous communities practically do not have this service. All this also comes from training in universities. It may not always be necessary to have palliative care physicians, but it is necessary to have surgeons who are knowledgeable about palliative care or internists who can identify when the end of a person’s life is approaching. patient admitted.
And how can this training be integrated into universities?
The curriculum should change, with a care subject that is transversal, that is, the provision of palliative care in all courses. For example, if you provide palliative care to surgical patients in general surgery; if you provide geriatric, palliative care for elderly patients or if you are in cardiology, palliatives for heart failure. Each specialty must be treated differently.
If the reality is that patients are dying in hospitals, let’s see what are the ways to give them the best possible death.
Only 25% of palliative care teams in Spain have psychologists and social workers. What is the impact of this lack?
The figure of the psychologist is fundamental and often absent. Obra Social La Caixa offers a specific program for people suffering from advanced illnesses. I have always worked with a psychologist and it is essential for me as a doctor to have this professional. The psychologist remains a “collector” of bad news, helps to assimilate the diagnosis, knows how to communicate it…
How does Spanish society perceive death: is there more openness or is it still a taboo?
This remains a taboo because, after all, this is an instrumental death because it occurs in the hospital. They die surrounded by IV bottles, masks, oxygen… These are very instrumental things. This does not allow caressing or kissing the patient.
How would you describe a “good enough death”?
A death closer to your values and the people you love.
On a personal level, what impact has your work had on your view of life and death?
I think we doctors are a little biased. In fact, I thought the ideal was to die at home, accompanied by your family, in your own bed and with your belongings. It was better to be away from the bells and the nurses, who can sometimes arrive in a bad mood. But then I realized that a lot of people were dying in hospitals, and that’s why I did this thesis. I said to myself: if the reality is that patients are dying inside hospitals, let’s see what are the ways to give them the best death.
Once the thesis was completed, I asked the family members if they would have wanted to change anything or if they would have preferred that their loved one had died at home and even what they themselves would wish for the future . Almost everyone told me they preferred the hospital. I think it gives them a certain security to be surrounded by professionals and to have the possibility of ringing a bell and being treated by a nurse.
