The word “palliate” means to relieve suffering. Palliative care is provided by a team, usually a doctor or two, nurses, social workers, and other clinicians that work in a hospital or other health care facility providing care for patients who come with physical symptoms that are causing them discomfort, and anxiety, or other mental health issues. Palliative care is often associated with the end of life, but it is also available to those who do not have a terminal illness but are in pain or psychological distress.
Palliative care can be given alongside treatment designed to cure the patient’s illness, such as chemotherapy or radiation. Nearly 75% of all U.S. hospitals offer palliative care teams, up from only 25% twenty years ago. A palliative care team is always interdisciplinary. Psychologists and counselors, social workers, chaplains, doctors, and nurses work on palliative care teams. Anyone diagnosed with a life-threatening illness like cancer, COPD, Alzheimer’s, kidney disease, or any serious illness can benefit from palliative care.
According to getpalliativecare.org, a website offered by the Center for the Advancement of palliative care, palliative care can relieve symptoms from pain and shortness of breath to fatigue, loss of appetite, and difficulty sleeping. Treatment for constipation and nausea as well as stress and anxiety are also targets of palliative care. Palliative care teams can provide information about a diagnosis, treatment options and support.
Palliative Care Increases Patient Satisfaction
Recently, my local hospital held a conference on palliative care (Cottage Hospital, January 14th, Santa Barbara: Ca.) where they have had a palliative care team for several years. They reported that when the palliative care team is engaged, primary care doctors and specialists feel less pressure and can focus on treatment. They also found that it leads to improved satisfaction with care for both patients and families and results in fewer visits to the ICU as well as a decrease in readmissions within the first 30 days after discharge.
The palliative care team not only provides comfort care and symptom reduction but also helps patients clarify the goals of treatment and create a set of Advanced Directives (hyperlink). Nearly 80% of palliative care patients leave the hospital for their homes where the palliative care team helps coordinate community resources, promoting continuity of care.
The National Institute on Cancer runs a Center for the advancement of palliative care which they describe as a “fundamental shift in healthcare delivery.” https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet
Reasons to choose Palliative Care
- It ensures time to devote to intensive family meetings and patient/family counseling
- Skilled communication about what to expect in the future in order to ensure that care is matched to the goals and priorities of the patient and the family
- Expert management of complex physical and emotional symptoms, including complex pain, depression, anxiety, fatigue, shortness of breath, constipation, nausea, loss of appetite, and difficulty sleeping
Coordination and communication of care plans among all providers and across all settings
The center for the Advancement of Palliative Care also notes that palliative care from an interdisciplinary, team-driven care focused on patient-centered outcomes improves the quality of life, symptom burden, emotional well-being, and caregiver well-being. They report the use of palliative care is associated with improved quality of life for patients and makes hospital admission less stressful and traumatic for the family. Its emphasis on communication and continuity of care, they believe, fits the episodic and long-term nature of a serious, multifaceted illness.
You can find information on this site that shows how palliative care can bring down the cost of hospital admission by over 40% as well as containing the costs of home care by as much as 36%. Medicare, Medicaid, and private insurance all usually cover the cost of palliative care. They also point to research that shows where palliative care is integrated into patient care, it can increase the rate of survival for patients.
Hospice vs. palliative care
At the conference I attended at Cottage Hospital, doctors and nurses observed that it is often shocking to patients and primary care doctors when the palliative team appears since most people associate palliative care with hospice. So, what is the difference between hospice and palliative care? To begin with, hospice care requires that the patient have a prognosis of no more than six months to live. Palliative care patients may have much longer to live than six months and may, in fact, survive their illness entirely.
To enter a hospice, a patient must have decided to forego all curative treatment. Hospice provides only comfort care and emotional support for the patient and the family. Palliative care can be administered at the same time as radiology or chemotherapy, surgery or any other procedure designed to prolong the patient’s life. In fact, the American Society for Clinical Oncology recommends that all patients with advanced cancer receive palliative care regardless of prognosis.
As the National Cancer Institute https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet puts it, palliative can begin at any point along the care continuum, while hospice care begins when curative treatment is no longer the goal of care and the sole focus is quality of life. You do not have to give up treatment that might cure a serious illness in order to receive palliative care. Palliative care can be provided along with curative treatment and may begin at the time of diagnosis.
Palliative care can help also patients and their loved ones make the transition from treatment meant to cure or control the disease to hospice care by preparing them for physical changes that may occur near the end of life and helping them cope with the thoughts and emotional issues that arise for patients in those final days and weeks.
providing support for family members.
The Team Approach
Six years ago, I was treated for colon cancer at the Cancer Care Alliance in Seattle where they use a team approach to care that includes palliative care. I was greeted by members of my team at every turn, from information provided by my nurse educator (Beta), a phlebotomist (Cindy) that was the same person each time I went in for infusions, a physician’s assistant (Heather) that followed me through the entire course of my treatment. I even had a personal pharmacist who reviewed all the medications I was prescribed and checked for interactions with the supplements I took.
I had access to a psychologist, a psychiatrist, a social worker, and a nutritionist as well a spiritual advisor, and, of course, my oncologist who reviewed my progress with a team of oncologists from time to time. I added a hairdresser who specialized in chemo hair and a trainer at the gym. I felt so well cared for, I can’t imagine going through such a major illness without that kind of support. You certainly feel like someone is listening to you and taking your issues seriously!
If you or someone you love has been diagnosed with a serious illness, you may want to find out whether the hospital or treatment center offers a team approach like palliative care. It can provide a port in the storm for both the patient and the family in one of the most difficult times of anyone’s life.