Palliative Care

April 2020 Vol 11, No 4

Categories:

Palliative Care
Michael Limerick, PhD, RN, ACNS-BC, CHPN
Palliative Care, APP, Medical City, Dallas, TX
Molly Sutton, MS, RN, OCN
Oncology Nurse Navigator, Medical City Healthcare, Dallas, TX

Most people have heard of palliative care, but few truly know the meaning. Palliative care is related to, but not the same as, hospice care. Palliative care is focused on improving the quality of life for patients who are living with a chronic or life-threatening disease. It is holistic and patient-oriented care, and it provides symptom management and psychosocial and spiritual support. The patient and his or her family are at the center of the palliative care team, which can provide support as the treatment moves along. Palliative care can be provided along with curative care, which might include surgery, chemotherapy, biotherapy, or radiation treatments. Hospice care is provided for patients who have a life expectancy of 6 months or less, and who can no longer benefit from curative treatment. Palliative care is provided for patients regardless of life expectancy. And while hospice care is palliative, not all palliative care is hospice (Figure 1).

Figure 1

Palliative care can be delivered to patients at any time during their course of illness and is focused on symptom management. For example, a patient receiving treatment for cancer may suffer from fatigue, pain, and chemotherapy- induced nausea. A patient who receives care to reduce these symptoms may be able to adhere to the treatment plan better than a patient who does not receive care to reduce these symptoms. Therefore, the patient who has received palliative care may survive longer than the patient who did not. In this case, palliative care would actually improve the chances of survival for a patient.

In another example, patients with an incurable and chronic illness can become depressed. Depression is associated with a lesser quality of life. Studies show that patients receiving palliative care early on during their course of treatment have a higher level of quality of life and a lower level of depression. It is thought that these patients develop coping skills, such as the use of emotional support systems, and learn to look at situations from a new perspective. Again, these patients, experiencing a higher quality of life and lower levels of depression, can have improved chances for survival.

Palliative Care vs Hospice Care

An oncologist has the option to order palliative care for patients when they are first diagnosed with cancer. However, many people still think that palliative care and hospice care are the same thing. They are not. Physicians may delay referral to palliative care because they do not want the patient to lose hope. Palliative practitioners are well aware of this fact and work hard to foster hope for their patients regardless of their condition.

One problem with a delay in referral is that communication about prognosis and the patient’s desires for endof- life care are not addressed until there is a health crisis. At this point, the patient and the family have not experienced any of the services that they could have been receiving from the palliative care team all along. They are unprepared for the sudden change in treatment strategy and may feel that they are “hitting the wall” of options. The patient may feel abandoned and confused if there are no more treatment options. It may seem to the patient that continuing aggressive therapy is the only option, and yet, there may not be any further aggressive treatment offered at this point. There is always care available, even when cure is no longer possible.

It is best for patients to receive palliative care early on in their course of treatment—ideally, as soon as they start treatment for a chronic or life-threatening disease (Figure 2). Symptom management started at the time of diagnosis can allow patients to successfully complete their prescribed course of aggressive treatment. Access to a palliative care team allows for patients and their family members to be involved in decision- making about their care from the beginning. Also, patients can be encouraged to have discussions with their family members about what they want at the end of life. Planning at the early stages of a chronic or life-threatening illness can ensure that a patient’s end-of-life preferences are observed.

Figure 2

Whether it is called palliative care, supportive care, or symptom management, help is available to patients and their family during the entire disease course. Palliative care teams believe it is important to always listen to patients and family members and honor the goals that are set forth. Having a goal or a direction for the treatment team as given by the patient does not mean that the goals will not change. There is an ongoing evaluation and revision of the goals the patient might desire, depending on the current course of treatment.

As President Dwight D. Eisenhower is quoted as saying, “Plans are nothing; planning is everything.” The palliative care team can empower the patients to personalize their plans and communicate this to the rest of their healthcare team. Working with palliative care allows the patients to be at the center of, and to remain in control of, their goals.

Sources

  • Davis M, Pennell N. The role of palliative care in lung cancer. In: Pass HI, Ball D, Scagliotti G, eds. IASLC Thoracic Oncology. 2nd ed. New York, NY: Elsevier; 2017:608-619.
  • Greer JA, Jacobs JM, El-Jawahri A, et al. Role of patient coping strategies in understanding the effects of early palliative care on quality of life and mood. J Clin Oncol. 2018;36:53-60.
  • Janjan N. Palliative care: meaningful benefit in oncology care. Oncology (Williston Park). 2011;25:1244, 1256.
  • Jones J. Benefits of palliative care. Prof Case Manag. 2015;20:262-264.
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Last modified: February 17, 2021

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