Palliative care, while formally recognized as a medical specialty in the US since 2006, has roots stretching back centuries, evolving from the hospice movement. Today, a significant majority of large hospitals, around 80 percent of those with 300 or more beds, integrate palliative care specialists or teams. These teams collaborate with a patient’s primary physicians to address a wide spectrum of distress – physical, social, and spiritual – arising from serious illnesses, their treatments, and complex care decisions. But what is included in a palliative care program? Let’s delve into the comprehensive nature of this patient-centered approach.
Understanding the Core of Palliative Care
At its heart, palliative care is about providing relief from the burdensome symptoms caused by disease or injury. It’s crucial to distinguish this from curative care, which aims to eradicate disease. Palliative care, conversely, focuses on enhancing comfort. The very definition of palliative care emphasizes making illnesses or their symptoms “less severe or unpleasant without removing the cause.” Essentially, palliative care seeks to lessen or “palliate” symptoms, significantly improving a patient’s overall quality of life.
Palliative Care vs. Hospice Care: Key Distinctions
It’s a common misconception to equate palliative care with hospice care, but they are distinct. While both share the goal of symptom management, hospice care is specifically designed for individuals in the last six months of life, as determined by their physician. Hospice is pursued when curative treatments are no longer the focus, whereas palliative care’s comfort-oriented approach is beneficial at any stage of illness, from initial diagnosis onward, even alongside curative treatments.
Palliative medicine is typically considered in the context of serious illnesses, including chronic and progressive conditions like pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS, progressive neurological conditions, and cancer. A central tenet of palliative care is to thoroughly inform both the patient and their family. This empowers them to define their care goals and desired outcomes – a process often referred to as a “Goals of Care Discussion.”
What are the Primary Goals of Palliative Care?
Palliative care programs are structured around several key goals, all aimed at improving the patient and family experience:
- Aligning Treatment with Patient Values: Ensuring medical treatments resonate with the patient’s personal values, beliefs, and preferences.
- Enhancing Quality of Life: Improving the overall well-being and daily living for both the patient and their family members.
- Minimizing Pain and Discomfort: Effectively managing physical pain and other distressing symptoms to maximize comfort.
- Alleviating Emotional and Psychological Distress: Addressing emotional challenges like anxiety, depression, and fear through counseling and support.
- Providing Practical Support: Assisting with safety concerns, mobility issues, and necessary medical equipment.
- Offering Spiritual Support: Providing spiritual counseling and guidance in alignment with the patient’s beliefs.
- Empowering Decision-Making: Equipping patients and their caregivers with the information and support needed to make informed healthcare decisions.
The Multidisciplinary Palliative Care Team
Palliative care is delivered by a team of specialized professionals, often mirroring the interdisciplinary approach found in hospice care. This team typically includes physicians, nurse practitioners, and registered nurses who conduct clinical evaluations and facilitate care discussions. Social workers and chaplains are also frequently integral members, providing psychosocial and spiritual support.
Benefits of Engaging with Palliative Care Services
Palliative care offers a wide array of benefits, fundamentally focusing on relief and improved well-being. 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 guidance, relaxation techniques like deep breathing, or complementary therapies like acupuncture.
Beyond physical relief, palliative care addresses the emotional and psychological burdens of serious illness. For patients and families grappling with a challenging diagnosis, palliative care provides crucial support for depression, anxiety, and fear. This is achieved through counseling, support groups, family meetings, and other therapeutic interventions.
Deep Dive: What Services Are Included in Palliative Care?
When considering what is included in a palliative care program, it’s important to understand the breadth of services offered. Palliative care typically begins with a comprehensive conversation. This initial assessment focuses on understanding the patient’s specific symptoms, needs, and current medications to identify potential avenues for relief. Sometimes, a palliative approach may involve deprescribing medications that are causing uncomfortable side effects.
Beyond medication management, palliative care also encompasses non-pharmacological approaches to address patient needs. This can include tailored nutritional plans or breathing exercises to manage symptoms. Furthermore, to enhance symptom relief, palliative care teams may introduce complementary therapies that target specific symptoms, always aiming for a holistic approach to care.
The specifics of each palliative care plan are highly individualized. Treatments are designed to address a patient’s unique needs and their tolerance for discomfort, ensuring personalized and patient-centered care. Regular communication is key. The palliative care team routinely checks in with the patient to assess the intensity of their pain and other symptoms. This ongoing feedback loop informs the collaborative process of determining the most appropriate treatment options.
For patients who are unable to communicate their needs, the palliative care team utilizes established pain assessment tools and their clinical expertise to facilitate symptom relief, ensuring that even non-verbal patients receive effective care.
Duration of Palliative Care: When Can It Begin and How Long Does It Last?
One of the significant advantages of palliative care is its flexibility. 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 including palliative care principles, is specifically for the last six months of life.
Research indicates that starting palliative care earlier in the course of a serious illness can lead to numerous positive outcomes. These include increased patient and family satisfaction with care, improved patient-reported pain levels, and, surprisingly, even improved patient survival rates in some cases. Importantly, if a patient in hospice care decides to discontinue hospice services, they can still continue to receive palliative care support.
Discussing Palliative Care with Your Healthcare Team
Navigating serious illness often brings worries that extend beyond just the medical aspects. A palliative care team member can be an invaluable resource in addressing these broader concerns. They can assist with questions and connect patients and families with resources to manage financial, legal, employment, transportation, and housing issues. Moreover, palliative care recognizes the importance of spiritual well-being. Whether a patient finds strength in their faith, feels disconnected from it, or has no religious background, palliative care can address spiritual questions in a way that respects their culture and traditions.
Above all, palliative care clinicians are trained to be attentive listeners. They prioritize understanding patients’ and families’ needs, goals, concerns, and questions. They take patient’s feelings and subjective experiences of pain seriously. Through skillful communication, they guide conversations to uncover unresolved issues, ensuring a comprehensive and truly patient-centered care plan.
The effectiveness of palliative care in improving quality of life is well-documented. When symptoms are effectively managed, and patients feel heard and supported, they experience a better quality of life. Furthermore, palliative care consultations can contribute to lower healthcare costs. By helping patients feel better and more in control, palliative care may enable them to avoid hospitalizations and decline tests or treatments that do not align with their personal goals.
VITAS Healthcare’s Approach to Palliative Care
At VITAS Healthcare, palliative care is initiated with a personalized plan developed by an interdisciplinary team tailored to each patient’s unique needs. This team supports individuals newly diagnosed with serious illnesses as well as those managing the effects of curative therapies. VITAS’ palliative care teams include professionals with diverse expertise, from physicians board-certified in hospice and palliative medicine to chaplains and social workers.
A palliative care consultation with VITAS provides patients and families with timely and specific information. This helps them understand the benefits of palliative medicine and enables physicians and the interdisciplinary team to deliver the most appropriate care. Should a patient’s symptoms escalate beyond routine palliative management, VITAS offers 24/7 availability to transition them to a higher level of care. This may include round-the-clock support from a crisis nurse until symptoms are controlled. For particularly aggressive symptoms, VITAS can facilitate transfer to an inpatient hospice unit for intensive symptom management, ensuring patients can return home when stable.
