Key Clinical Questions
What are the primary palliative care skills that every hospitalist should know?
What is specialty palliative care and how does it differ from hospice?
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 ||Download (.pdf) 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
TABLE 214-2Areas of Palliative Care ||Download (.pdf) 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 |
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 at any point in the disease trajectory from ...