Curative or therapeutic care refers in part to treatments and therapies provided to a patient with the goal of curing an illness or condition. The terms are also used for treatments that delay disease progression even when a cure is not possible. It is important to understand the risks and benefits of any curative or therapeutic care so you can make the best choices for you and your life. Shared decision making can help you with that understanding.
What is curative or therapeutic care?
Curative or therapeutic care is what we usually think of simply as care. We have a sore throat, we go to the doctor, they diagnose strep throat and prescribe an antibiotic, we take it, and the sore throat goes away. More complicated problems often involve more complicated treatments. The challenge is that there is often more than one way to treat a given problem and that each treatment choice has different risks and benefits.
Examples of curative care include:
- Antibiotics for bacterial infections
- Chemotherapy or radiation therapy for cancer
- Cast for a broken bone
- Dialysis treatment for kidney failure
- Surgery for appendicitis
- Acupuncture for certain conditions
- Dietary programs for certain conditions
How do I learn about my choices of curative care?
The best way to learn about your choices is from your own doctor. They know you and your condition best. There are also good general resources available on the internet such as Mayo Clinic or American Cancer Society. One challenge is when there are several possible treatments for the same condition and a choice must be made among them. Decision aids have been developed that will help you sort out which treatment might work best for you and your life. The Ottawa Hospital Research Institute has created a series of decision aids for various conditions that are quite useful.
Another concept that has gained acceptance is shared decision making.
What is shared decision making?
Shared decision making is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans based on clinical evidence that balances risks and expected outcomes with patient preferences and values. Here is a one page description of shared decision making from HealthIT.gov.
In many situations, there is no single “right” healthcare decision because choices about treatment, medical tests, and health issues come with pros and cons. Shared decision making is especially important in these types of situations:
- When there is more than one reasonable option, such as for screening or a treatment decision;
- When no one option has a clear advantage; and
- When the possible benefits and harms of each option affect patients differently.
Some healthcare systems use shared decision making in their process and electronic healthcare records. Ask your doctor how they use shared decision making.
What are the questions I should ask my doctor about curative care?
There are a number of resources available to help you prepare for a discussion with you doctor. A general list has been prepared by the Agency for Healthcare Research and Quality. The American Board of Internal Medicine Foundation created the Choosing Wisely ® campaign to improve healthcare quality. More than 70 specialty societies have identified commonly used tests or procedures within their specialties that are good to discuss with your doctor before use.
General questions to ask your doctor include:
- Do I really need this test, treatment or procedure?
- What do you expect the benefits to be?
- What are the risks?
- Are there simpler, safer options?
- What happens if I don’t do anything?
- How much will it cost?
- How will it affect the quality of my life and my ability to do the things I like to do?
It is always good to write down anything you want to share with your doctor and to make notes when you are there. Ask for an explanation of anything you do not understand. It may also be helpful to take someone with you, as in the moment you may miss some information and they can help you be sure you understood everything properly.
Will I receive curative care if I chose hospice care while on Medicare?
The issue of curative care comes up when a patient has a terminal illness and is considering hospice care. Medicare covers hospice care (Source: MedicareResources.org), but a patient who has switched to Medicare’s hospice benefit will only have palliative care coverage for their terminal illness (Source: Palliative Doctors) — curative care would not be covered. So, a patient with terminal cancer can opt for Medicare’s hospice benefit but would have to cease chemotherapy and instead receive care designed to provide comfort and alleviate pain.
But that doesn’t mean you won’t have coverage for any curative care. If you experience a medical problem that’s not related to the terminal illness, Medicare will cover curative care for that issue, although there may be some charge depending on your insurance.
And Medicare beneficiaries have the option to stop their hospice benefit at any point and return to regular Medicare coverage. So, if a you decide that you would rather continue to seek curative care instead of palliative care, you have that choice.