Skip to main content
PMC home page
Springer Nature - PMC COVID-19 Collection logoLink to Springer Nature - PMC COVID-19 Collection
. 2021 Nov 5;27(10):723–728. doi: 10.1007/s11655-021-3500-9

Reframing Palliative Care: An East-West Integrative Palliative Care Model

S Anjani D Mattai 1, Ka-Kit P Hui 1,2,✉
PMCID: PMC8570069  PMID: 34739681

Abstract

Convergence of principles of palliative care and integrative medicine has led to the introduction of the new practice of integrative palliative care in which integrative therapies (including mind-body modalities, traditional Chinese medicine, Ayurveda, and dietary supplements) are used to provide symptom management for patients who are dying or experiencing the sequelae of serious illness and its treatment. We propose an East-West Integrative palliative care model using non-drug therapies, such as acupuncture, diet, exercise, and stress management that shift the paradigm from suppressing the symptoms of illness to addressing both the root cause of the symptoms and the imbalance and declining homeostatic reserve that perpetuate these symptoms. This whole-person model expands the reach of palliative care, prolonging a better quality of life and allowing the patient to maintain as many activities as possible by preventing symptoms and improving function. Through this approach we reframe the dialogue such that patients are “living better” rather than “dying better” when faced with serious illness or death. In this article, we provide an overview of the principles of palliative care, integrative medicine, and the novel area of integrative palliative care, and propose an East-West integrative palliative care model that incorporates and broadens the scope of these existing approaches.

Keywords: person-centered model, palliative care, integrative medicine, traditional Chinese medicine, acupuncture, symptom management, cost-effectiveness, reframing healthcare

Acknowledgements

We would like to thank the Panda Charitable Foundation, the Gerald Oppenheimer Family Foundation and the Annenberg Foundation for their partial support in this work. We would also like to thank Vincent Tse for his help in the preparation of this manuscript.

References

  • 1.Carter R. Cicely Saunders—founder of the hospice movement: selected letters 1959–1999. J R Soc Med. 2003;96:149–151. [Google Scholar]
  • 2.NHPCO, editor. History of hospice. 2021. [Google Scholar]
  • 3.Richmond C. Dame Cicely Saunders. BMJ. 2005;331:238. doi: 10.1136/bmj.331.7510.238. [DOI] [Google Scholar]
  • 4.Center for Palliative Care. Accessed on Apr 30, 2021. Available at: https://pallcare.hms.harvard.edu/.
  • 5.Morrison RS, Augustin R, Souvanna P, Meier DE. America’s care of serious illness: a state-by-state report card on access to palliative care in our nation’s hospitals. J Palliat Med. 2011;14:1094–1096. doi: 10.1089/jpm.2011.9634. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.WHO Definition of Palliative Care/WHO Definition of palliative care for children. In: Geneva: World Health Organization. 2002 Accessed on Mar 29, 2021. Available at: http://www.who.int/cancer/palliative/definition/en/.
  • 7.Clinical Practice Guidelines for Quality Palliative Care. 4th ed. In: National Consensus Project for Quality Palliative Care. 2018. Accessed on Apr 30, 2021. Available at: https://www.nationalcoalitionhpc.org/ncp/.
  • 8.Integrating palliative care and symptom relief into primary health care: a WHO guide for planners, implementers and managers. Geneva: World Health Organization; 2018. Available at: https://apps.who.int/iris/handle/10665/274559.
  • 9.Kelley AS, Morrison RS. Palliative care for the seriously ill. N Engl J Med. 2015;373:747–755. doi: 10.1056/NEJMra1404684. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Institute for Healthcare Improvement. In: Institute for Healthcare Improvement. Accessed on Apr 30, 2021. Available at: http://www.ihi.org:80/Engage/Initiatives/TripleAim/Pages/default.aspx.
  • 11.National Academies of Sciences, Engineering,Medicine, HealthMedicine Division, Board on Health Sciences Policy, Board on Health Care Services, Roundtable on Quality Care for People with Serious Illness. Models and strategies to integrate palliative care principles into care for people with serious illness: proceedings of a workshop. Washington (DC): National Academies Press (US); 2017. [PubMed] [Google Scholar]
  • 12.El-Jawahri A, Greer JA, Temel JS. Does palliative care improve outcomes for patients with incurable illness? A review of the evidence. J Support Oncol. 2011;9:87–94. doi: 10.1016/j.suponc.2011.03.003. [DOI] [PubMed] [Google Scholar]
  • 13.Morrison RS, Penrod JD, Cassel JB, Caust-Ellenbogen M, Litke A, Spragens L, et al. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168:1783–1790. doi: 10.1001/archinte.168.16.1783. [DOI] [PubMed] [Google Scholar]
  • 14.Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. New Engl J Med. 2010;363:733–742. doi: 10.1056/NEJMoa1000678. [DOI] [PubMed] [Google Scholar]
  • 15.Adelson K, Paris J, Horton JR, Hernandez-Tellez L, Ricks D, Morrison RS, et al. Standardized criteria for palliative care consultation on a solid tumor oncology service reduces downstream health care use. J Oncol Pract. 2017;13:e431–e440. doi: 10.1200/JOP.2016.016808. [DOI] [PubMed] [Google Scholar]
  • 16.Enguidanos S, Vesper E, Lorenz K. 30-day readmissions among seriously ill older adults. J Palliat Med. 2012;15:1356–1361. doi: 10.1089/jpm.2012.0259. [DOI] [PubMed] [Google Scholar]
  • 17.Greer JA, Tramontano AC, McMahon PM, Pirl WF, Jackson VA, El-Jawahri A, et al. Cost analysis of a randomized trial of early palliative care in patients with metastatic nonsmall-cell lung cancer. J Palliat Med. 2016;19:842–848. doi: 10.1089/jpm.2015.0476. [DOI] [PubMed] [Google Scholar]
  • 18.Ziegler LE, Craigs CL, West RM, Carder P, Hurlow A, Millares-Martin P, et al. Is palliative care support associated with better quality end-of-life care indicators for patients with advanced cancer? A retrospective cohort study. BMJ Open. 2018;8:e018284. doi: 10.1136/bmjopen-2017-018284. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Brumley RD, Enguidanos S, Cherin DA. Effectiveness of a home-based palliative care program for end-of-life. J Palliat Med. 2003;6:715–724. doi: 10.1089/109662103322515220. [DOI] [PubMed] [Google Scholar]
  • 20.Lustbader D, Mudra M, Romano C, Lukoski E, Chang A, Mittelberger J, et al. The impact of a home-based palliative care program in an accountable care organization. J Palliat Med. 2017;20:23–28. doi: 10.1089/jpm.2016.0265. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Heist RS, et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol. 2012;30:394–400. doi: 10.1200/JCO.2011.35.7996. [DOI] [PubMed] [Google Scholar]
  • 22.Academic consortium for integrative medicine and health: introduction. In: Academic Consortium for Integrative Medicine and Health. Accessed on Apr 30, 2021. Available at: https://imconsortium.org/about/introduction/.
  • 23.Integrative Medicine and the Health of the Public: A summary of the February 2009 summit. National Academies Press (US); 2009. Available at: https://www.ncbi.nlm.nih.gov/books/NBK219637/. [PubMed]
  • 24.Engel GL. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–136. doi: 10.1126/science.847460. [DOI] [PubMed] [Google Scholar]
  • 25.Greene JA, Loscalzo J. Putting the patient back together— social medicine, network medicine, and the limits of reductionism. N Engl J Med. 2017;377:2493–2499. doi: 10.1056/NEJMms1706744. [DOI] [PubMed] [Google Scholar]
  • 26.Complementary, alternative, or integrative health: what’s in a name? In: NCCIH: National Center for Complementary and Integrative Health. 2021. Accessed on Apr 30, 2021. Available at: https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health-whats-in-a-name.
  • 27.Homeopathy: what you need to know. In: NCCIH: National Center for Complementary and Integrative Health. 2021. Accessed on Apr 30, 2021. Available at: https://www.nccih.nih.gov/health/homeopathy.
  • 28.Adler SR, Marchand LR, Heap N. Integrative palliative care: enhancing the natural synergy between integrative health and palliative medicine. J Altern Complement Med N Y N. 2019;25:257–259. doi: 10.1089/acm.2019.29063.sra. [DOI] [PubMed] [Google Scholar]
  • 29.Chiaramonte DR, Adler SR. Integrative palliative care: a new transformative field to alleviate suffering. J Altern Complement Med N Y N. 2020;26:761–765. doi: 10.1089/acm.2020.0366. [DOI] [PubMed] [Google Scholar]
  • 30.Palliative care fact sheet. Accessed on Apr 30, 2021. Available at: https://www.who.int/news-room/fact-sheets/detail/palliative-care.
  • 31.Jansen K, Haugen DF, Pont L, Ruths S. Safety and effectiveness of palliative drug treatment in the last days of life—a systematic literature review. J Pain Symptom Manage. 2018;55:508–521.e3. doi: 10.1016/j.jpainsymman.2017.06.010. [DOI] [PubMed] [Google Scholar]
  • 32.Hui KK T. Proceedings of a WHO international symposium. 2001. potential for incorporating traditional Chinese medicine into clinical practice. Traditional medicine: better science, policy and services for health development. [Google Scholar]
  • 33.Pritzker S, Katz M, Hui KK. Person-centered medicine at the intersection of East and West. Eur J Pers Center Health. 2013;1:209–215. doi: 10.5750/ejpch.v1i1.653. [DOI] [Google Scholar]
  • 34.Hui KK, Li ZL. The University of California at Los Angeles Center for East-West medicine’s patient-centered integrative East-West medical approach. Chin J Integr Tradit West Med (Chin) 2018;38:484. [Google Scholar]
  • 35.Wu XQ, Hui KK. Progress in scientific research bridging traditional Chinese and modern medicine in the UCLA-CEWM clinical model. Chin J Integr Tradit West Med (Chin) 2019;39:1500–1505. [Google Scholar]
  • 36.Hui KK, Hui EK, Johnston MF. The potential of a person-centered approach in caring for patients with cancer: a perspective from the UCLA center for East-West medicine. Integr Cancer Ther. 2006;5:56–62. doi: 10.1177/1534735405286109. [DOI] [PubMed] [Google Scholar]
  • 37.Birch S, Bovey M, Alraek T, Robinson N, Kim TH, Lee MS. Acupuncture as a treatment within integrative health for palliative care: a brief narrative review of evidence and recommendations. J Altern Complement Med N Y N. 2020;26:784–791. doi: 10.1089/acm.2020.0032. [DOI] [PubMed] [Google Scholar]
  • 38.Miaskowski C, Barsevick A, Berger A, Casagrande R, Grady PA, Jacobsen P, et al. J Natl Cancer Inst. 2017. Advancing symptom science through symptom cluster research: expert panel proceedings and recommendations; p. 109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39.Huang T, Hung T, Kim S, Hui K. Acupuncture for management of symptom clusters in a patient with metastatic breast cancer: a case report. OBM Integr Complement Med. 2020;5:1–6. doi: 10.21926/obm.icm.2001011. [DOI] [Google Scholar]
  • 40.Balboni TA, Hui KP, Kamal AH. Supportive care in lung cancer: improving value in the era of modern therapies. Am Soc Clin Oncol Educ Book. 2018;38:716–725. doi: 10.1200/EDBK_201369. [DOI] [PubMed] [Google Scholar]

Articles from Chinese Journal of Integrative Medicine are provided here courtesy of Nature Publishing Group

RESOURCES