Palliative care is often confused with hospice care, which is comfort care for patients who only have a few months or less to live. While palliative care may be given as someone nears death, it has a broader scope and may also be given at diagnosis, during treatment, and/or after treatment to help patients with chronic or life-threatening illness, such as cancer and HIV/AIDS.
This article explores the elements of palliative care along with the types of treatments that may be involved. It also details when palliative care is needed, including the criteria used by healthcare professionals and health insurers.
Scope of Care
The ultimate aim of palliative care is to improve a person’s quality of life when faced with a serious or life-threatening illness. It can begin at any time during an illness, last days or even years, and be provided along with curative treatments.
Palliative care is not restricted to people receiving end-of-life care. It can be offered to anyone whose illness is reducing their quality of life, impacting their ability to function normally, or placing an undue burden on family or caregivers.
The scope of palliative care may involve:
Providing relief from pain and/or symptoms of a diseaseCoordinating care between medical and non-medical providersMinimizing side effects from treatmentsAddressing the emotional, spiritual, and social needs of the individualIdentifying and supporting the needs of the family or caregivers
Palliative Care Team
Palliative care is typically carried out by a team of professionals who can address multiple concerns. It may be offered by hospitals, home care agencies, cancer treatment centers, and long-term care facilities. The care team may include:
Palliative care doctors Nurses and nurse practitioners Pharmacists Social workers Psychologists Registered dietitians Chaplains, rabbis, or other spiritual leaders Therapists (occupational, speech, physical, massage, etc. )
Palliative care is a specialized field of medicine. For doctors, board certification in palliative care is through the American Board of Medical Specialities (ABMS). Nurses and nurse practitioners can get certified through several credentialing organizations.
Ultimately, the most important member of the care team is you. Palliative care should be directed toward meeting your personal goals and needs. It is important to make your wishes known and to encourage your family and caregivers to do the same.
Treatment
Improving someone’s quality of life involves tending to more than just their physical concerns. As such, palliative care is a holistic approach intended to ease emotional, social, practical, and spiritual challenges as well.
Palliative care treatment may be aimed at any of the following, as appropriate:
Physical problems, such as pain, sleeping problems, breathing difficulty, loss of appetite, constipation, and nausea or vomiting Emotional or social problems, including depression, anxiety, family issues, caregiver burnout, and lack of support Practical problems, including insurance, financial, legal, housing, or job-related issues Spiritual issues, including hopelessness and a loss of faith
The benefits of palliative care are many. Palliative care may not only improve a person’s quality of life, as well as that of their family, but it may also help extend their life.
According to a review published in the Annals of Behavioral Medicine, people with advanced cancer receiving palliative care had survival times more than 30% longer than those who received only standard care. However, some other studies haven’t found a survival advantage.
Criteria and Eligibility
Historically, palliative care was used in people with incurable cancer and was largely synonymous with hospice care. Over time, the definition has evolved and broadened. Today, palliative care can be applied to many serious or life-threatening conditions, whether terminal or non-terminal.
In addition to cancer, palliative care may be used in people with:
Congestive heart failure (CHF) Chronic obstructive pulmonary disease (COPD) Stroke HIV/AIDS Advanced kidney disease Advanced liver disease Neurodegenerative disorders like Alzheimer’s disease, Parkinson’s disease, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS)
While the decision to pursue palliative care is largely an individual one, there are certain criteria health professionals use to assess the need for such care.
According to the Center to Advance Palliative Care, the criteria can vary based on who is assessing the patient.
Criteria categories include:
General clinical criteria: May include multiple hospitalizations, declining ability to take care of oneself, severe weight loss, a need for tube feeding in severely ill people, difficult-to-control symptoms, and extreme patient or caregiver distress Intensive care unit (ICU) criteria: May include two more ICU admissions during the same hospitalization, multi-organ failure, prolonged ventilator use, and ICU admissions from nursing homes in people with multiple health concerns (e. g. , dementia and heart failure) Emergency room (ER) criteria: May include multiple prior hospitalizations for the same condition, long-term care patients with a do not resuscitate (DNR) order, and people previously enrolled in hospice or home health care Oncology (cancer) criteria: May include a poor performance status (PS), failure of first-line or second-line chemotherapy, painful bone metastases (cancer spread), progressive brain metastases after radiation, and the need for interventional pain management
There may also be eligibility criteria for insurance coverage. Medicare, for example, only covers palliative care for certain conditions. Furthermore, while Medicare Part B covers certain palliative care services (like doctor’s fees), Medicare Part A benefits can only be applied to hospice care.
Summary
Palliative care is aimed at relieving the symptoms and improving the quality of life of people with serious or life-threatening illnesses. It may be included as a part of hospice care, but it is not the same thing as hospice care. With palliative care, you can still receive care whether your condition is terminal or not.
Palliative care is often delivered by a team of providers, including medical and allied health professionals. The scope of care not only includes medical services like pain control and respiratory care, but may also address the person’s emotional, practical, and spiritual needs.
The criteria for palliative care services can vary by the medical condition, the health status of the individual, and other factors. But it is ultimately aimed at bringing comfort to people faced with severe illnesses of many types.
A Word From Verywell
If your doctor recommends palliative care, this does not necessarily mean that you or your loved one are at end of life. While palliative care may be a part of hospice care, it is not hospice care. The aim of palliative care is to make your and your family’s life better, irrespective of life expectancy or whether your condition is curable or incurable.
Furthermore, if you enroll in hospice care but later change your mind, you can continue to receive palliative care (although there may be certain insurance).
If you are unclear why palliative care has been recommended, speak with your doctor or seek a second opinion from a medical specialist certified in palliative and hospice care.
