Palliative Care: What It Is, What It Is Not

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Palliative

Palliative care emerged in the 1980s as a holistic, team approach to supporting patients suffering from serious medical conditions. It is not the same thing as hospice care. While both focus on making the patient more comfortable, the difference is that hospice is called for when the patient has a prognosis of impending death. Palliative care, quite on the other hand, focuses on life.

The difference between the two is significant, but not widely known. In fact, more than 78 percent of adults in the United States are not exactly sure what palliative care is.1 Even some members of the medical community believe that palliative care is just a synonym for hospice. Some doctors understand the difference but don’t recommend palliative care because they’re concerned the patient may interpret it to mean hospice and believe that they’re dying.

Moreover, more than 50 percent of directors of nursing do not understand the basics of palliative care, according to new study. This research found that the more familiar the director of nursing was with palliative care, the greater the chances that their patient’s experienced end-of-life cares aligned with a higher quality of life focus.

While hospice patients no longer receive curative treatment for their underlying disease, palliative care is available at any stage of illness and can be deployed in conjunction with curative treatment. It is not associated with any particular age, illness or stage of illness, and is appropriate for anyone suffering from a serious illness, whether chronic or acute.

Team Approach,
Palliative care is provided by a team of professionals, usually in concert with the patient’s primary physician for a specific condition. This team is developed to meet the special needs of each patient and therefore can vary significantly. Examples of palliative care team specialists include trained palliative care doctors and nurses, social workers, psychologists, dietitians, nutritionists, massage therapists, pharmacists, chaplains and even art or music therapists — whatever is most appropriate for the patient. Even if the primary physician is not technically a member of the palliative care team, he supervises the patient’s care and plays an active role in ongoing treatment.

The healing scope of the palliative care team is broader than that of traditional doctors. Their focus is on preventing pain, alleviating suffering, improving quality of life and helping both the patient and his loved ones cope with the stress and burden of caregiving. The team works to make the patient become as independent as possible, emphasizing what the patient actually wants instead of what a traditional medical approach might dictate that he needs. This approach gives patients more control over their treatment plan.

For example, an aging parent diagnosed with cancer may be worried about who will care for his mentally incapacitated adult son to the degree that he forgoes scheduled treatments to stay home with the dependent. This scenario may call for a social worker who is able to procure resources to help care for the son and provide transportation to and from chemotherapy sessions for the father. A palliative care team addresses physical, mental and social conditions, and studies have revealed that curative treatment can also be more effective when accompanied by palliative care.

Access
Because palliative care is not that well known, access is an issue. Most of the time it is recommended by the treating physician and frequently provided by on-site teams in a hospital setting. However, palliative care can be provided wherever the patient is located, including outpatient clinics, long-term-care facilities, hospices and even at home.

Palliative care also can be recommended via other sources, such as health and mental health agencies, day care and senior centers, schools, courts, child welfare and family service agencies, correctional systems, agencies serving immigrants and refugees, substance abuse programs and employee assistance programs. While the foundation of the program is to provide pain and symptom relief, these types of organizations may be engaged due to the patients’ lifestyle, socio-economic factors, immigration status and/or living environment. Social service agencies are frequently able to identify these factors and refer patients who would benefit from palliative care before their conditions are exacerbated and require more costly treatment.

Palliative care is generally covered all or in part by Medicare, Medicaid and most insurance plans. However, Medicaid coverage can vary depending on the state program.

  1. Health Affairs Blog. March 10, 2015. “Effective Public Engagement To Improve Palliative Care For Serious Illness.”http://healthaffairs.org/blog/2015/03/10/effective-public-engagement-to-improve-palliative-care-for-serious-illness/. Accessed April 14, 2015.
  1. Journal of Hospice and Palliative Nursing. October 2012. “Opportunities and Challenges for Palliative Care Professionals in the Age of Health Reform.” http://www.nursingcenter.com/lnc/cearticle?tid=1429239. Accessed April 8, 2015.
  1. NYmag.com. “Many Nursing Homes Fall Short at Palliative Care.” March 24, 2015.http://nymag.com/scienceofus/2015/03/many-nursing-homes-fall-short-at-palliative-care.html. Accessed April 8, 2015.
  1. Pharmacy Practice News. March 2015. “Palliative Care a ‘Foreign’ But Vital Role for Pharmacists.”http://www.pharmacypracticenews.com/ViewArticle.aspx?d=Clinical&d_id=50&i=March+2015&i_id=1155&a_id=30832. Accessed April 8, 2015.
  1. National Association of Social Workers. “NASW Standards for Palliative & End of Life Care.”https://www.socialworkers.org/practice/bereavement/standards/default.asp.” Accessed April 8, 2015.
  1. GetPalliativeCare.org. “Frequently Asked Questions.”http://getpalliativecare.org/whatis/faq/#how-do-i-know-if-palliative-care-is-right-for-me. Accessed April 8, 2015.
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