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Section 11: Palliative Care

Principles of Palliative Care

INTRODUCTION

Key Clinical Questions

  • image What are the primary palliative care skills that every hospitalist should know?

  • image What is specialty palliative care and how does it differ from hospice?

  • image How do you identify patients in need of a palliative care assessment in a hospital setting?

Palliative care focuses on effective management of pain and other distressing symptoms, and integrates psychosocial and spiritual care by considering a patient’s and family’s needs, preferences, values, beliefs, and culture (see Table 214-1). The palliative care approach works to improve quality of life for the patient and family by reducing a patient’s symptom burden, providing clear communication about what to expect in the future, and aligning realistic treatment options with patient- and family-determined goals of care (see Table 214-2).

TABLE 214-1Palliative Care Services
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TABLE 214-1 Palliative Care Services

  • Provides relief from pain and other distressing symptoms

  • Will enhance quality of life and may also positively influence the course of illness

  • Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy

  • Includes those investigations needed to better understand and manage distressing clinical complications

  • Integrates the psychological and spiritual aspects of patient care

  • Offers a support system to help patients live as actively as possible until death

  • Affirms life and regards dying as a normal process

  • Intends neither to hasten or postpone death

  • Offers a support system to help the family cope during the patient’s illness and in their own bereavement

  • Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated

Reproduced with permission from World Health Organization’s Definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en. Accessed April 7, 2015.

TABLE 214-2Areas of Palliative Care
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TABLE 214-2 Areas of Palliative Care
Area Examples
Physical Pain, shortness of breath, nausea, fatigue, weakness, anorexia, insomnia, confusion, constipation, treatment side effects, functional capacities, treatment efficacy and alternatives (and patient and family preferences)
Psychological/psychiatric Anxiety, depression, care-giving needs or capacity of family; stress; grief and bereavement risks for the patient and family (ie, depression and comorbid complications); coping strategies
Social Family structure and geographic location; cultural concerns and needs; finances; sexuality; living arrangements; caregiver availability; access to transportation; access to prescription and over-the-counter medicines
Spiritual/religious/existential Spiritual background, beliefs, and practices of the patient and family; hopes and fears; life completion tasks; wishes regarding care setting for death

Data from National Consensus Project for Quality Palliative Care. 2009. Clinical Practice Guidelines for Quality Palliative Care, 2nd ed.

Unlike hospice, which requires that a physician endorse a 6-month prognosis in order for a patient to qualify for hospice services, palliative care (sometime referred to as supportive care), is provided in conjunction with curative treatment ...

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