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A person recently diagnosed with a potentially terminal illness may bristle at the suggestion of palliative care. Courage and bravery are noble virtues often attributed to people living with or dying from a serious illness — and to someone with a new diagnosis, the term “palliative care” may sound synonymous with surrender.
Even many doctors falsely believe palliative care is relevant only during the last weeks of life. (2) But palliative care is focused on the relief of symptoms and comfort of the patient, regardless of whether or not the illness in question is terminal. (1)
Palliative care specialists work in teams to address a patient’s pain, nausea, shortness of breath and other unpleasant symptoms. The team can help a patient weigh the pros and cons of various treatments, and evaluate a particular treatment’s potential to extend life versus its side effects.
A 2010 study of 151 lung cancer patients revealed that patients receiving palliative care immediately upon diagnosis reported less depression and worry, experienced less pain and lived nearly three months longer than patients receiving standardized care, according to The New York Times. (2)
Donald G. McNeil Jr., science and health reporter for The New York Times, wrote “... even though substantially fewer of them opted for aggressive chemotherapy as their illnesses worsened and many more left orders that they not be resuscitated in a crisis, they typically lived almost three months longer than the group getting standard care, who lived a median of nine months.” (2)
To reiterate, terminal patients who receive palliative care instead of traditional care can live longer. Palliative care specialists, doctors, nurses, counselors and social workers, help patients discern treatment decisions throughout their illness.
The team can also address the emotional impact of the illness and its treatment, the financial burden on family, and the daily minutiae of meals, dressing and personal care.
The issue was politicized in 2009 when access to palliative care proposed for the Affordable Care Act, also known as Obamacare, was disparagingly referred to by opponents as “death panels.”
In reality, rather than hastening death, science confirms that discussions with doctors about comfort care prolongs life, and promises an improved quality of life. (5) Unfortunately for research, the pharmaceutical industry has little to gain financially from palliative care that weighs both the pros and cons of various treatments, so they are unlikely to fund future studies. (2)
A patient can request palliative care at any stage of an illness, curable, chronic or terminal. Palliative care is not synonymous with hospice care. The term hospice, which refers historically to a place of rest and refuge for weary travelers, is primarily for patients likely to die within the next six months.
Hospice encompasses palliative care, (2) but also presumes the cessation of life-prolonging treatment. In contrast, palliative care has no time limits and can be provided concurrent with treatment whether or not the illness is terminal. (3)
For further reading:
“Die Wise: A Manifesto for Sanity and Soul,” by Stephen Jenkinson
“How We Die: Reflections of Life's Final Chapter” by Sherwin B. Nuland
“Being Mortal: Medicine and What Matters in the End” by Atul Gawande
Sources:
1) Frequently Asked Questions About Hospice and Palliative Care. palliativedoctors.org. Retrieved November 21, 2015.
http://palliativedoctors.org/faq
2) Palliative Care Extends Life, Study Finds. NYTimes.com. Retrieved November 21, 2015.
http://www.nytimes.com/2010/08/19/health/19care.html
3) Hospice Vs. Palliative Care. caregiverslibrary.org. Retrieved November 21, 2015.
http://www.caregiverslibrary.org/caregivers-resources/grp-end-of-life-issues/hsgrp-hospice/hospice-vs-palliative-care-article.aspx
4) History of Hospice Care. NHPCO.org. Retrieved November 21, 2015.
http://www.nhpco.org/history-hospice-care
5) Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. NEJM.org. Retrieved November 21, 2105.
http://www.nejm.org/doi/full/10.1056/NEJMoa1000678
Reviewed November 23, 2015
by Michele Blacksberg RN
Edited by Jody Smith
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