Chapter 215. Principles of Palliative Care

1. What is the best approach for patients with serious or advanced chronic illness?

2. What do patients and families consider important at this time?

3. What signs and symptoms suggest that a patient is dying?

4. What steps can be taken to relieve symptoms in patients with advanced illness?

Hospitalized patients with advanced illness have a high burden of symptoms including pain, nausea, and dyspnea. These symptoms can arise from the disease itself as well as from the therapies used to treat it. They can arise at any point in the course of illness and can significantly diminish quality of life. Palliative care is the field of medicine focused on symptom management and improving quality of life for patients living with a life-threatening illness (Morrison & Meier, 2004), whether the goals for care include cure, life prolongation, or living with a chronic illness. Palliative care expertise includes the assessment and treatment of pain and other symptoms, and the relief of suffering caused by thye physical, psychosocial, and spiritual aspects of disease. Unlike hospice, which requires that a physician endorse a six-month prognosis in order for a patient to qualify for service, palliative care, sometimes also referred to as supportive care, is provided in conjunction with curative treatment at any point in the disease trajectory from the time of diagnosis (Figure 215-1). As a patient becomes sicker, palliative care may become a greater focus either because the burden of curative treatments outweighs the benefits or they are no longer effective or because the patient no longer desires them. Palliative care is provided by an interdisciplinary team including physicians, nurses, social workers, pharmacists, psychologists, and chaplains (Morrison & Meier, 2004). Palliative care teams treat not only the patient, but also attend to the needs of the family, understanding that family can include any person the patient identifies as part of his or her support network. Palliative care is provided early in the course of illness and across multiple care settings; therefore, communication among the varied settings and continuity of care is essential to achieving quality care for patients (Table 215-1).