August Spotlight — Palliative Care: What it is and what it is not

Submitted by Karl Ahlswede, MD, FACS, Medical Director, Palliative Care

 

Palliative Care has a very wide scope of focus and, because of this, it is difficult to provide a concise definition. It is often said that palliative care is end-of-life care or hospice. That definition is incorrect and far too restrictive.

 

Palliative care focuses on providing patients with relief from the symptoms of an illness whatever the diagnosis or life expectancy. The symptoms encountered could be physical (pain, difficulty breathing, GI distress), emotional (fear, anxiety, sadness) or spiritual (existential angst or fear of the unknown). The goal of palliative care is to utilize a wide range of treatment modalities (medications, meetings regarding the goals of treatment and prayer are a few examples) to address symptoms and thereby improve the quality of life for both the patient and the patient’s loved ones.

 

In this regard, a physician who prescribes pain medicine or a nurse repositioning a patient to maximize comfort or a chaplain praying with a patient or a social worker meeting with a family to discuss a loved one’s medical condition are all providing palliative care.

 

While everyone involved in health care delivery is associated with palliative care to some extent, the complicated nature of current medical treatments has brought about the need for palliative care to be practiced as a recognized medical specialty. There is specialty certification for physicians, advanced practice nurses and registered nurses and there are palliative care teams active in a majority of the hospitals in the United States.

 

Most palliative care in the US is delivered in hospitals to inpatients by interdisciplinary teams consisting of medical practitioners (doctors, advanced practice nurses and registered nurses), chaplains and social workers. There is a desire and a growing trend to offer specialized palliative care in the outpatient setting, but this has been limited by the number of specialists that are trained and able to deliver this care.

 

Palliative care is applicable to anyone receiving medical care, and it becomes more important if the medical care is for a long term, painful or life threatening condition. This is likely the reason that palliative care is often thought to be the same thing as hospice care. Simply stated, hospice care is palliative care delivered to a patient when most, if not all, life prolonging medical treatment is no longer being delivered.

 

Palliative care has been shown to increase patient and loved one’s satisfaction as well as decrease the length of time patients spend in the hospital and the amount of money spent on medical care. The presence of palliative care teams in hospitals has also been shown to increase staff nurse satisfaction within those institutions.

 

Palliative care is a win-win situation for patients, their loved ones and for society as a whole.

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