Palliative care, while formally recognized as a medical specialty in the US since 2006, has roots stretching back centuries, evolving from the hospice movement’s focus on comfort. Today, a significant majority – around 80 percent – of hospitals with 300 or more beds in the United States now feature palliative care specialists or teams. These dedicated professionals collaborate with a patient’s primary physicians to holistically address the multifaceted distress – physical, social, and spiritual – that can arise from serious illnesses, their treatments, and the complex care decisions that accompany them.
Understanding Palliative Care: More Than Just Comfort
At its core, palliative care is specialized medical care focused on providing relief from the symptoms and stress of a serious illness. It stands in contrast to curative care, which aims to eliminate disease. Palliative care, as defined, seeks “to make a disease or its symptoms less severe or unpleasant without removing the cause.” Essentially, it’s about lessening the burden of symptoms and significantly improving a patient’s overall quality of life, regardless of their prognosis.
Palliative Care vs. Hospice Care: Key Differences
It’s crucial to distinguish palliative care from hospice care, although they are related. While both share a focus on symptom management and enhancing comfort, hospice care is specifically for individuals nearing the end of life, typically defined as having a prognosis of six months or less, as determined by a physician. Hospice care is pursued instead of curative treatments, whereas palliative care is available at any stage of illness, from the point of diagnosis onwards, and can be received alongside curative treatments.
Palliative medicine is typically considered in the context of serious illnesses, including chronic and progressive conditions such as pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS, progressive neurological conditions, and cancer. A central aspect of palliative care is to openly discuss treatment options, potential outcomes, and limitations, empowering patients and their families to make informed choices about their care. This process is often referred to as a “Goals of Care Discussion,” ensuring that treatment aligns with what matters most to the individual.
What Are the Primary Goals of Palliative Care Programs?
Palliative care programs are guided by several core objectives designed to enhance the well-being of patients and their families. These goals include:
- Aligning Treatment with Patient Values: Ensuring that medical treatments and care plans are in harmony with the patient’s personal values, beliefs, and preferences.
- Enhancing Quality of Life: Improving the overall quality of life for both the patient and their family members who are often deeply affected by the illness.
- Minimizing Pain and Discomfort: Actively working to reduce physical pain and other sources of discomfort associated with the illness or treatment.
- Addressing Emotional Distress: Providing support to alleviate emotional distress, anxiety, and depression that can accompany serious illness.
- Assisting with Practical Needs: Offering assistance with safety, mobility issues, and necessary medical equipment to improve daily living.
- Providing Spiritual Support: Offering spiritual counseling and support to address existential questions and spiritual needs.
- Empowering Decision-Making: Empowering patients and their caregivers to actively participate in making informed decisions about their healthcare journey.
The Interdisciplinary Palliative Care Team: Who Is Involved?
Palliative care is delivered through a team-based approach, much like hospice care, utilizing an interdisciplinary team of professionals. Typically, this team includes physicians, nurse practitioners, and registered nurses who provide clinical evaluations and lead care discussions. Social workers and chaplains are also frequently integral members, offering psychosocial and spiritual support. This multidisciplinary team ensures that all aspects of a patient’s needs are addressed comprehensively.
Benefits of Palliative Care: Relief and Improved Well-being
The advantages of palliative care are wide-ranging, offering relief across various dimensions of a patient’s experience. Physical symptoms, such as pain, fatigue, appetite loss, nausea, vomiting, and sleep disturbances, can be effectively managed through palliative approaches. These may include medications, nutritional strategies, relaxation techniques like deep breathing, or complementary therapies such as acupuncture, depending on the patient’s needs and preferences.
Beyond physical comfort, palliative care addresses the significant emotional and psychological challenges that can arise with a serious diagnosis. Counseling, support groups, and family meetings are utilized to help patients and families cope with depression, anxiety, and fear. This holistic approach ensures that both the physical and emotional burdens of illness are addressed.
Delving Deeper: What Is Included in a Palliative Care Program?
A palliative care program is not a one-size-fits-all solution. It is a personalized approach to care, tailored to meet the unique needs of each patient. The process often begins with a comprehensive conversation to thoroughly understand the patient’s specific symptoms, individual needs, and current medications. This initial assessment is crucial for developing a targeted care plan. So, what is included in a palliative care program in detail? It encompasses a range of services and interventions, including:
-
Comprehensive Symptom Management: This is a cornerstone of palliative care. It includes the assessment and management of a wide array of physical symptoms like pain, shortness of breath, fatigue, nausea, constipation, and sleep problems. It also extends to managing psychological symptoms such as anxiety, depression, and delirium. The team uses various strategies, including medication, therapies, and lifestyle adjustments, to alleviate these symptoms and improve comfort.
-
Medication Review and Management: Palliative care teams often review a patient’s current medications to identify any that might be causing uncomfortable side effects or are no longer necessary. In some cases, discontinuing certain medications can be a significant palliative measure, improving the patient’s comfort and reducing medication burden.
-
Non-Pharmacological Therapies: Beyond medications, palliative care emphasizes non-drug approaches to symptom relief. These can include specialized nutritional guidance to address appetite loss or metabolic changes, breathing exercises for managing shortness of breath, physical therapy to maintain mobility and function, and complementary therapies like massage, acupuncture, or music therapy to address specific symptoms and enhance well-being.
-
Emotional and Psychological Support: Serious illness can take a significant emotional toll. Palliative care programs provide crucial emotional and psychological support through counseling, individual therapy, support groups, and family meetings. These services help patients and families cope with the emotional challenges of illness, including fear, anxiety, depression, grief, and stress.
-
Spiritual Care and Support: For many individuals, spirituality is an important source of comfort and meaning, especially during challenging times. Palliative care programs often include chaplains or spiritual counselors as part of the team. They offer spiritual support tailored to the patient’s beliefs and traditions, helping them explore existential questions, find meaning and purpose, and connect with their spiritual resources.
-
Communication and Shared Decision-Making: Open and honest communication is fundamental to palliative care. The program facilitates conversations between patients, families, and the medical team to ensure everyone is informed and involved in care decisions. This includes discussions about treatment options, goals of care, prognosis, and end-of-life planning, ensuring that patient preferences are honored.
-
Practical and Logistical Support: Palliative care recognizes that illness can create practical challenges beyond medical symptoms. Programs often assist patients and families in navigating financial, legal, employment, transportation, and housing issues related to their illness. Social workers on the palliative care team can provide resources and referrals to address these practical needs, reducing stress and improving overall well-being.
-
Coordination of Care: Navigating the healthcare system can be complex, especially with serious illness. Palliative care programs help coordinate care between different healthcare providers and settings, ensuring seamless transitions and continuity of care. They act as a central point of contact, facilitating communication and collaboration among all members of the patient’s care team.
The specifics of what is included in a palliative care program are intentionally flexible, adapting to the unique circumstances and needs of each patient. Treatments are designed to address the individual’s particular symptoms, preferences, and tolerance for discomfort. Regular communication between the palliative care team and the patient is maintained to continuously assess symptom intensity and adjust treatment plans accordingly, ensuring the most effective and patient-centered care possible. When a patient is unable to communicate directly, the team utilizes validated pain assessment tools and clinical judgment to ensure effective symptom relief.
Duration of Palliative Care: Available When You Need It
Palliative care is not limited by time or prognosis. It can be initiated at any point during an illness, for any duration, and can be received concurrently with curative treatments. This contrasts with hospice care, which, while encompassing palliative care principles, is specifically intended for the last six months of life.
Research indicates that initiating palliative care earlier in the course of serious illness can lead to better outcomes, including increased patient and family satisfaction, improved pain management, and even potentially improved survival rates in some conditions. Importantly, patients receiving hospice care who choose to discontinue hospice services can still continue to benefit from palliative care.
Engaging Your Healthcare Provider in a Palliative Care Discussion
For patients and families facing the multifaceted challenges of serious illness, including concerns extending beyond the illness itself, palliative care teams are invaluable resources. Members of a palliative care team can provide assistance in navigating financial, legal, employment, transportation, and housing concerns. Furthermore, palliative care recognizes and addresses spiritual needs, regardless of an individual’s faith background, offering support and resources that are culturally and personally relevant.
Palliative care clinicians are specially trained to prioritize listening to patients’ and families’ needs, goals, concerns, and questions. They take patient-reported experiences, including subjective experiences of pain, seriously and skillfully guide conversations to uncover unresolved issues and inform a comprehensive, patient-centered care plan.
The effectiveness of palliative care in enhancing quality of life is well-documented. By effectively managing symptoms and providing a supportive and listening environment, palliative care helps patients feel better and live more fully. Palliative care consultations have also been shown to potentially reduce healthcare costs by empowering patients to manage their symptoms effectively at home and make informed decisions about treatments that align with their goals, potentially reducing hospitalizations and the use of aggressive interventions that may not be desired.
VITAS Healthcare’s Approach to Palliative Care
At VITAS Healthcare, palliative care is initiated with a customized plan developed by an interdisciplinary team to precisely address each patient’s unique needs. The team collaborates with patients who are newly diagnosed as well as those managing the effects of curative therapies. VITAS palliative care teams include professionals with diverse expertise, including physicians board-certified in hospice and palliative medicine, chaplains, social workers, and other specialists.
A palliative care consultation with VITAS provides patients and families with timely and specific information, clarifying the benefits of palliative medicine and enabling physicians and the interdisciplinary team to deliver the most appropriate and effective care. Should a patient’s symptoms escalate beyond what can be managed with routine palliative care, VITAS offers 24/7 support to transition patients to a higher level of care, including round-the-clock support from crisis nurses until symptoms are controlled. For particularly aggressive symptoms, VITAS can facilitate transfer to an inpatient hospice unit for intensive symptom management until the patient is stable enough to return home, ensuring comprehensive and responsive care at every level.
