Palliative Care is the active total care of the body, mind, and spirit of the patient and family. The purpose of palliative care is to prevent or lessen the severity of pain and other symptoms and to achieve the best quality of life for people dying or suffering from a life-altering disease. Palliative care does not exclude therapies aimed at cure, but seeks to complement them.
What is Palliative Care?
Prior to the development and use of the term palliative care, the word hospice was used to indicate care provided to patients as they neared the end of life. The word hospice originates from Roman times. Throughout the early centuries religious communities ran establishments dedicated to the care of the sick and dying. These early hospices took a very holistic approach to care and focused on the specific needs of a dying individual.
The distinction between hospice care and palliative care can be confusing. From a medical perspective, palliative care is considered to be a broader term covering all forms of the prevention and treatment of suffering, while hospice is generally seen as a subset of palliative care directed to those nearing the end of life.
Palliative care is appropriate whenever symptoms causing pain and suffering are present. The term palliative care was first used during the 1970’s. Dr. Balfour Mount opened a hospital-based palliative care program at the Royal Victoria Hospital of McGill University in Montreal, Canada focusing on research and education regarding pain control. He felt the need for a term that was broader than hospice.
The World Health Organization (WHO) developed their palliative care definition in 1990: Palliative care is the active, total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best possible quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of illness, in conjunction with cancer treatment.
Palliative care:
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Affirms life and regards dying as a normal process;
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Neither hastens nor postpones death;
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Provides relief from pain and other distressing symptoms;
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Integrates the psychological and spiritual aspects of patient care;
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Offers a support system to help patients live as actively as possible until death;
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Offers a support system to help the family cope during the patient’s illness…and in their own bereavement.
This definition stresses the terminal nature of chronic diseases such as cancer. However, the term can also be used more generally to refer to anything that alleviates symptoms, even if there is also hope of a cure by other means. A more recent WHO statement calls palliative care an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness.
Palliative treatments may be used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherapy. The term palliative care is not generally used when addressing the treatment of certain chronic diseases such as diabetes which, although currently incurable, has treatments that are (ideally) effective enough that it is not considered a progressive or life threatening disease in the same sense as cancer.
Though the concept of palliative care is not new, in the past, most doctors concentrated on aggressively trying to cure patients. Concentrating on making a patient comfortable was seen as “giving up” on them. As the understanding of the concept of palliative care and its focus on the individual’s and family’s quality of life, has become more widespread, it is now accepted in the healthcare system as a standard of care. Some systems and organizations have embraced the word “palliative” as an addition to “hospice”, such as the National Hospice and Palliative Care Association (NHPCO).
Models of Palliative Care
There are a number of different ways to provide hospice and palliative care. A palliative care consult team may be called in to assist physicians when it is difficult to manage a severely ill patient’s pain and symptoms. A palliative care review may occur at the time a patient is diagnosed with a specific disease or when the disease becomes substantially worse and the entire care team helps address a patient's body, mind and spirit needs to help the patient maintain a good quality of life.
Interdisciplinary palliative care includes several types of healthcare providers and addresses the patient’s and family’s needs including pain and symptom management, as well as practical, spiritual and emotional issues. Palliative interventions can improve a patient’s quality of life regardless of diagnosis or the ultimate goal of care.
The recognition of palliative care as an area of specialization is growing. Board certification for physicians in palliative care is available through the American Board of Hospice and Palliative Medicine and other organizations in different countries. Certification for nurses and pharmacists in palliative care is now recognized as an important part of an interdisciplinary palliative care team.
Ideally, patients should have a palliative care consultation when a diagnosis is made even though most of the patient’s care is directed towards cure of the disease. This helps maximize a patient's quality of life by addressing needs of the body, mind and spirit throughout the disease journey.
