New and emerging technologies are developing at a rapid rate.  This is already leading to new frontiers in the diagnosis of illness and the options available for treatment together with helping individuals better maintain their own health and wellbeing. 

Medical advancements are occurring in artificial intelligence (AI) and information and communications technology (ICT) and in the fields of biotechnology and precision medicine, which can tailor medications and therapies to the unique biological makeup of the individual.  These developments are revolutionising health care now and will continue to do so into the future.

Palliative care is not immune from these changes and clinicians working in palliative care will find themselves working with new technologies and data sources to inform their practice and care of palliative patients.

Looking forward to the next 10 or so years, patients and consumers will have access to a range of data that has not previously been available to them.   Health professionals will increasingly need to adapt their service models to include the patient as a key resource in health decision making acknowledging that patients will have more information about their own health at their fingertips.  The use of smart technology will be used to monitor a person’s health and wellbeing.  Smart technology will routinely measure heart rate, blood pressure, breathing, weight, activity levels and could potentially predict when people are at risk of stroke, heart attack or other diseases and conditions. 

Access to remote monitoring of health data will increase and this will mean that where individuals want this option, their data collected through smart technology will also be available to their health care teams.  Clinicians can then be alerted earlier to a change in diagnosis or a need to change treatment options. 

Not only will there be more data at the individual level, data collected at the macro level will also have implications for diagnosis and treatment options.  Big data and artificial intelligence will have a greater role to play in medical forecasting and treatment. 

What can this mean in practice? According to the Australian Council of Learned Academies (ACOLA) there will be “increasing ability to collect and codify clinical and laboratory data in aggregate through the use of big data tools – including supercomputing capacity, cloud storage and automated biometric, diagnostic and therapeutic data collection – allowing association of genomic and related information with biomarkers, diagnosis and clinical outcome.”[1]  This will enable patients to have a real-time medical condition assessment, which will lead to point-of-care interventions and predictive analytics for clinical decision-making.  Based on this information, health and support services can be more preparative and responsive and less reactive. 

In a similar vein, the computing power of artificial intelligence will assist scientists and pharmaceutical clinicians develop new and responsive medications that are directly related to a person’s biological system and specific disease symptoms. 

This is the area where clinicians will see the biggest change – the tailoring of treatments to meet the biological make-up of their patients. The emerging field of biotechnology and precision medicine will mean that life-limiting illness is easier to predict and biological markers will provide a clearer indication of life expectancy for many people with varying diagnoses.  As noted by the ACOLA, precision medicine is “the ability to analyse disease in terms of an individual’s make-up, when compared with and studied alongside aggregated clinical and laboratory data from healthy and diseased populations. Although medicine has always had personal and predictive aspects, precision medicine allows health and disease to be viewed at an increasingly fine-grained resolution, attuned to the complexities of both the biology of each individual and variation within the population.”[2]  In other words, there will be an increasing move away from a one size fits all approach for disease treatment and prevention to very tailored individual treatment and prevention plans.

This will mean that the treatment of life-limiting illnesses such as cancer or neurodegenerative diseases will be managed using knowledge about an individual’s biological system to increase the efficacy of treatment outcomes.  This will include immunotherapy, which enables a person to use their own immune system to fight off a disease.  This could reduce the need for radiotherapy, chemotherapy or surgery.  If a person does needs chemotherapy, the emerging field of nanotechnology will increasingly be used to target cancer cells without the current side effects.

So what does this all mean for palliative care clinicians?

Emerging treatment and interventions using advanced biotechnological options and incorporating the benefits of big data and artificial intelligence will mean that many people will be kept alive for longer and where they need serious treatment, the side effects should be less physically diminishing than in the past and currently.

So while all these advances are generally positive, the fact remains that people will still have life-limiting illness and will need help living with the symptoms of their illness while also preparing for their death.  It is also known that the dominant illnesses accounting for growth in palliative care need will be dementia and cancer.[3]  According to the CSIRO, there will be an increase in neurodegenerative disorders, and a changing spectrum of cancers as the common cancers become more survivable…the associated increasing lifespans will see more individuals develop rare and less common cancers such as pancreatic and renal.”[4] 

Comorbidity will be significant factor in palliative care.  Many people will live with more than one comorbid condition.  “This means that the complexity of palliative care need is likely to grow due to the high symptom burden, complex healthcare needs and high hospitalisation rates of patients with multimorbidity”.[5] 

To manage all of these factors will require a sophisticated array of skills.  Consumers will expect their health practitioners to be able to work with the latest technological advancements and incorporate biotechnology and precision medicine into care and treatment options and to minimise negative side-effects.  Specifically for palliative care, patients and their carers will depend on the skills, knowledge and experience of palliative care clinicians in interpreting the data and assessing the multitude of treatment options to determine the best care path available.

In addition to the changes that emerging medical advances and technologies will have for the care options available to people with life-limiting illness, palliative care clinicians will increasingly be called on to advise patients about when enough is enough for treatment proposed by other medical clinicians.  The growing accessibility of biotechnology options will run the risk of more people being on a treatment treadmill and there will always be a point where further treatment will be too burdensome or non-beneficial.  Palliative care expertise will be needed more than ever to advise patients about when to stop more active treatments and interventions and to ensure patients have quality of life and avoid unnecessary pain and distress.

It is important that palliative care remains a human service within the context of this changing world.  Technology needs to be balanced with the counterforce of human contact and kindness together with the expertise to advise and guide people about what is best for them.  In addition to the high quality medical care and treatment provided by palliative care clinicians, palliative care will continue to provide high quality psychosocial, emotional and spiritual care for the person receiving palliative care along with grief and bereavement support for family and loved ones. 

We are entering a new age where some things will change dramatically but the core essence of what palliative care offers now will be needed more than ever into the future.

[1] Australian Council of Learned Academies (ACOLA), The Future of Precision Medicine in Australia,  page 3 accessed at https://acola.org.au/wp/wp-content/uploads/PMED-20180524.pdf

[2] Ibid, page 2.

[3] Etkind, S.N., Bone, A.E., Gomes, B., Lovell, N., Evans, C.J. Higginson, I.J., and Murtagh, F.E.M., How Many People will Need Palliative Care in 2040?  Past trends, future projections and implications for services in BMC Medicine (2017) 15:102.

[4] CSIRO, Future of Health: Shifting Australia’s Focus From Illness Treatment to Health and Wellbeing Management, 2018, pages vi and 7. (Accessed at: https://www.csiro.au/en/Do-business/Futures/Reports/Future-of-Health).

[5] Etkind, et al (2017).