By definition, palliative care focuses on decreasing pain and suffering through pain and symptom management along with emotional and spiritual support, regardless of age. Palliative care is closely associated with hospice care, but the distinction is that it is not just for the dying. Palliative care may also be referred to as “end-of-life” care.
Although these three terms may be used interchangeably, there are a couple of differences. Palliative care and hospice/end-of-life care focuses on pain and symptom management, but the difference between them is that with the former the patient’s condition doesn’t have to be terminal and they may still be undergoing aggressive treatment. With hospice or end-of-life care, the patient’s prognosis is terminal with a life expectancy of less than six months and the patient is no longer undergoing curative treatment.
“In both ... the focus is on quality of life of the patient. The goal for both types of care is to address any adjustment to illness or end-of-life issues.” (University of Maryland Medical Center)
Palliative care is available at any time during an illness, particularly if a patient is undergoing life-saving or life-prolonging treatments. Whether or not palliative care is available to a patient is not determined based on whether or not your condition can be cured. The goal of palliative care during this time is to make a patient as comfortable as possible and improve quality of life during treatment.
Looking Closer at Palliative Care
In addition to providing relief from pain and other symptom management, palliative care (adapted from the World Health Organization):
• “affirms life and regards dying as a normal process;
• Intends neither to hasten or postpone death;
• Integrates the psychological and spiritual aspects of patient care;
• Offers a support system to help patients live as actively as possible until death;
• Offers a support system to help the family cope during the patient’s illness and in their own bereavement;
• Uses a team approach to address the needs of patients and their families ...
• Will enhance quality of life, and may also positively influence the course of illness;
• Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.”
Palliative Care Patient and Caregiver Support Services
As we’ve already learned, palliative care includes pain management, symptom management and emotional and spiritual support for the patient. Emotional and spiritual support is kind of obvious, but let’s look at the difference between pain management and symptom management.
Pain management is necessary to ensure the patient’s comfort and reduce their distress. Health care professionals and family members usually work together to identify sources of pain and what treatments (including drugs and other therapies) to implement to address the pain issue.
Symptom management treats symptoms other than pain, such as “nausea, weakness, bowel and bladder problems, mental confusion, fatigue, and difficulty breathing.” (Journal of the American Medical Association)
Obviously, there is stress on family members during this time, and palliative care serves to address that aspect of patient care as well. This is done through health care professionals educating family members about the patient’s condition and problems, and advise the family about giving medication and recognizing symptoms that may require immediate medical attention. “Home support services may provide help with transportation, shopping, and preparing meals. Respite care provides relief and time off to the caregiver.” (Journal of the American Medical Association)
It is also important that families with members receiving palliative care seek help with developing a financial plan to manage issues such as loss of income and added expenses, and that they create a support network including other family members, friends, and clergy to help caregivers manage the psychological and spiritual stress of palliative care.
Sources:
University of Maryland Medical Center http://www.umm.edu/palliative/palliative_hospice.htm
Journal of the American Medical Association (http://jama.ama-assn.org/content/296/11/1428.full.pdf
Hospice Foundation of America http://www.hospicefoundation.org/uploads/hic_fs_hospice.pdf
National Institute of Nursing Research http://www.ninr.nih.gov/NR/rdonlyres/01CC45F1-048B-468A-BD9F-3AB727A381D2/0/NINR_PalliativeBrochure_Brochure_12_Layout_Version_508.pdf
Health Canada
http://www.hc-sc.gc.ca/hcs-sss/palliat/index-eng.php
World Health Organization
http://www.who.int/cancer/palliative/definition/en
Reviewed on August 25, 2011
by Maryann Gromisch
Edited by Jody Smith