Patients Teach Doctor How to Heal at the End of Life

What People Really Want
at Life’s End

Stanford University palliative care expert, Dr. Vyjeyanthi “V.J.” Periyakoil believes most patients don’t simply want every medical intervention that may or may not prolong their lives. Rather people want appropriate care sensitive to their quality of life and, enabling them to experience their final days as fully as possible with minimal stress for their families.

In fact, a 2012 report by the California Health Care Foundation affirmed Periyakoil’s understanding of what patients hope for.

1. People do not want their families burdened by the cost of their care

2. They do not want to struggle with troubling decisions about their treatment.



3. Finally, participants said they wanted to be comfortable without pain and hoped to be “at peace spiritually.”

4. In a list of the 10 most important factors at the End of Life, people placed the desire “to live as long as possible” down at number 10. 


5. Patients cared more about concrete things - “Treat my pain first, take care of me first - then you can treat me with respect.”

6. Patients and their families want good pain care and symptom management, which is good palliative care.

While at Stanford Medical School, Dr. Periyakoil studied geriatric medicine, and discovered another gap in her knowledge from patients who were deemed to have only six months or less left to live. Admitted to hospice care, their cure-oriented medical treatment would often be stopped in favor of “comfort” care.

“I had a hard time giving up on these patients,” she admits.

She wanted to improve the quality of their lives, no matter how much time they had left, so she realized that palliative treatment should begin as soon as a patient is diagnosed with a life-threatening disease. Care provided only when someone becomes eligible for terminal hospice coverage comes too late to fully help him or her.

As an example, the average hospice stay in the United States is now only 19 days. But palliative medicine begun much earlier reduces the agony and stress of disease so well that many patients actually survive longer. And family caregivers, relieved of constant stress, have been shown to live longer following a loved one’s death.

“Palliative care should be woven seamlessly into treatment,” noted Periyakoil, “Patients shouldn’t have to know the word ‘palliative care.’ It should be something that is given to you when and where you need it because it is the standard practice.”

At Stanford’s Palliative Care Education and Training Program, Dr. Periyakoil’s fellows embrace her holistic approach. “Palliative care is one of the few fields of medicine where you deal with the whole person,” says Dr. Thui Pham, an internist. “There are so many factors that impact life, not just the medical issues.”

“Palliative care is not about the end of life,” Dr. Periyakoil concurs. “It’s about how a patient can get the most out of every day.”

Dr. Vyjeyanthi “V.J.” Periyakoil. Periyakoil is an associate director of Palliative Care Services at the VA Palo Alto Health Care System. ■