DEFINITION & SCOPE OF PALLIATIVE CARE
The focus of palliative care is to improve symptoms and quality of life at any stage of any serious illness, to support patients’ families and loved ones, and to help align patients’ care with their preferences and goals. At the end of life, palliative care often becomes the sole focus of care, but palliative care alongside cure-focused treatment is beneficial throughout the course of a serious illness, regardless of prognosis, whether the goal is to cure disease or manage it.
According to The Center to Advance Palliative Care, "Palliative care is specialized medical care for people with serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work with a patient's other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment."
Palliative care includes management of physical symptoms, such as pain, dyspnea, nausea and vomiting, constipation, and agitation; emotional distress, such as depression, anxiety, and interpersonal strain; and existential distress, such as spiritual crisis. While palliative care is a medical subspecialty recognized by the American Board of Medical Specialties (“specialty palliative care”), all clinicians routinely should provide “primary palliative care” and possess the basic skills to be able to manage pain; treat dyspnea; identify possible depression; communicate about important issues, such as prognosis and patient preferences for care; and help address spiritual distress. Advanced certification in palliative care is offered by the Joint Commission to hospitals providing high-quality palliative services. The World Health Organization has adopted a resolution calling for the integration of palliative care services into the structure and financing of national healthcare systems.
During any stage of illness, symptoms that cause significant suffering are a medical emergency that should be managed aggressively with frequent elicitation and reassessment as well as individualized treatment. While patients at the end of life may experience a host of distressing symptoms, pain, dyspnea, and delirium are among the most feared and burdensome. Management of these common symptoms is described later in this chapter. The principles of palliative care dictate that properly informed patients or their surrogates may decide to pursue aggressive symptom relief at the end of life even if, as a known but unintended consequence, the treatments preclude further unwanted curative interventions or even hasten death, although increasingly, palliative care has been shown to prolong life.
et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015 May 1;33(13):1438–45.