Palliative care basics
Palliative care is comprehensive treatment of the discomfort, symptoms, and stress of serious illness. It does not replace your primary treatment; palliative care works together with the primary treatment you’re receiving. The goal is to prevent and ease suffering and improve your quality of life.
Palliative care identifies and treats symptoms which may be physical, emotional, spiritual or social. Because palliative care is based on individual needs, the services offered will differ but may include:
• Relief of pain and other symptoms e.g. vomiting, shortness of breath
• Resources such as equipment needed to aid care at home
• Assistance for families to come together to talk about sensitive issues
• Links to other services such as home help and financial support
• Support for people to meet cultural obligations
• Support for emotional, social and spiritual concerns
• Counselling and grief support
• Referrals to respite care services
Palliative care can improve your quality of life in a variety of ways. Together with your primary health care provider, your palliative care team provides pain and symptom control with every part of your treatment. Team members spend as much time as it takes with you and your family to help you fully understand your condition, care options, and other needs. They also help you make smooth transitions between all the settings where you may receive care (the hospital, nursing facilities, or home care).
This results in well-planned, complete treatment for all of your symptoms throughout your illness—treatment that takes care of you in your present condition and anticipates your future needs.
Who is palliative care for?
Palliative care is for everyone of any age who has been told that they have a serious illness that cannot be cured. Palliative care assists people with illnesses such as cancer, motor neurone disease and end-stage kidney or lung disease to manage symptoms and improve quality of life. For some people, palliative care may be beneficial from the time of diagnosis with a serious life-limiting illness. Palliative care can be given alongside treatments given by other doctors.
How palliative care differs from hospice care?
Although you may hear “palliative care” and “hospice care” used in similar ways, they are not the same. Palliative care is given at every step of the treatment process. Hospice care is a specific type of palliative care. It is only provided to people with incurable disease who are expected to live six months or less so that they may live as fully and comfortably as possible. All hospice is palliative care, but not all palliative care is hospice.
When to receive palliative care?
Palliative care should begin at the time of diagnosis of a serious condition and continue through cure, or until death and then into the family’s bereavement period (Low Quality Evidence, Strong Recommendation) (Temel, 2010; Kass-Bartelmes, 2004; Steinhauser, 2000; Morrison, 2004). Both clinicians and patients generally don’t recognize early on those individuals who would benefit from palliative care planning. Early identification of patients with conditions that would benefit from palliative care can be accomplished by considering conditions and symptoms that are appropriate for palliative care services.
General considerations clinicians should use to identify patients who would benefit from palliative care include:
• disease progression, especially with functional decline;
• pain and /or other symptoms not responding to optimal medical treatment; and
• need for advance care planning.
Conditions that may prompt the initiation of palliative care discussions include these (this is not intended to be an all-inclusive list):
Debility/Failure to Thrive
• Greater than three chronic conditions in patient over 75 years old • Functional decline • Weight loss • Patient/family desire for low-yield therapy • Increasing frequency of outpatient visits, emergency department visits, hospitalizations
• Uncontrolled symptoms due to cancer or treatment • Introduced at time of diagnosis – if disease likely incurable • Introduced when disease progresses despite therapy
• Stage III or IV heart failure despite optimal medical management • Angina refractory to medical or interventional management • Frequent emergency department visits or hospital admissions • Frequent discharges from implanted defibrillators despite optimal device and antiarrhythmic management
• Oxygen-dependent, O2 sats less than 88% on room air • Unintentional weight loss • Dyspnea with minimal to moderate exertion • Other pulmonary diagnoses, e.g., pulmonary fibrosis, pulmonary hypertension
• Refractory behavioral problems • Feeding problems – weight loss • Caregiver stress – support needed • Frequency of emergency department visits • Increased safety concerns
• Increased need for paracentesis for removal of ascitic fluid • Increased confusion (hepatic encephalopathy) • Symptomatic disease Renal Disease • Dialysis • Stage IV or Stage V
Neurologic • Stroke • Parkinson’s • ALS – amyotrophic lateral sclerosis • MS – multiple sclerosis
Palliative care is a team approach to patient-centered care.
Every palliative care team is different. Your palliative care team may include:
• social workers
• religious or spiritual advisors
• counselors and others