Palliative Care Brings Comfort to Chronically, Terminally Ill Patients

Over the last few decades, it has become apparent that, in the United States, there is a growing and increasingly urgent need for a specialty that deals with the symptoms of advanced chronic diseases and with the physical, spiritual and emotional needs of patients near the end of life. The rapid advance of the "Boomer" generation into the senior citizen age group is increasing the demands on healthcare providers, particularly those who deal with chronic illnesses.

The newest specialty recognized by the American Board of Medical Specialties is hospice and palliative medicine (HPM). Palliative care is a discipline that specializes in the treatment of disease, regardless of whether or not those conditions can be cured.

The number of HPM physicians in the U.S. is small, but the field is growing rapidly. Palliative care programs are springing up in hospitals all over the country. Larger urban hospitals and academic centers are leading the charge, but smaller towns and rural areas are increasingly obtaining access to HPM services.

Palliative care teams are the core of any good hospice program, and may also be found in skilled nursing facilities or working with home health providers.

Palliative care is typically provided in a team format. In addition to physicians, core team members include registered nurses, medical social workers and chaplains/spiritual counselors. In addition, psychologists, volunteers, therapists (physical. occupational, speech), pharmacists, nursing assistants, dieticians and non-medical caregivers may also play a role. They recognize that chronic illnesses cause more than just physical pain; a variety of symptoms may be addressed, such as shortness of breath, nausea, constipation, anxiety, insomnia and restlessness. Just as crucial, however, is the team approach to managing the non-physical symptoms of chronic illnesses: emotional stress, financial concerns, family discord, guilt, anger, depression, post-traumatic stress disorder, spiritual suffering, existential issues, cultural conflicts and many other concerns.

An important element is that the palliative care team does not care for the patient in isolation, but rather the patient's entire family and support system are incorporated into the treatment plan and are considered to be a part of the palliative care team. Support from family, friends and caregivers of an ill patient can make a major difference in quality of life. Common goals are identified, and each member of the team contributes toward attaining these goals.

Who might need palliative care services? Recipients of palliative care may be anyone who has an illness, usually chronic in nature, with a burden (physical, emotional, spiritual) that is creating suffering. Most people needing our services are elderly, but age in no way limits who may receive support. Common illnesses for which palliative care may be of great help include cancer (before, during or after treatment), chronic heart disease or congestive heart failure, chronic lung disease, HIV/AIDS, degenerative diseases (dementia, Parkinson's, ALS), stroke, severe osteoporosis with associated fractures and debility, chronic kidney failure, and advanced diabetes with complications.

Some patients with advanced medical conditions will eventually become eligible for hospice care. Hospice is a Medicare Part A benefit, and most private insurers take the lead from Medicare and use similar criteria. Patients are eligible for hospice care, if they have a desire for comfort-oriented care, and if their physicians suspect they are likely in the last six months of their lives. Of course, doctors don't have a crystal ball to accurately foretell the future, but through education and experience they develop an ability to prognose life expectancy. Hospice and palliative care physicians are some of the best at estimating prognosis, and this information is often invaluable for patients and their families. It has been gratifying that several studies in recent years have shown that patients who are placed in a hospice program actually live longer than similar patients who continue to be treated as usual. This outcome is generally attributed to the excellent symptom management and focus on quality of life that hospice patient receive. Additionally, the incidence of emotional problems (such as prolonged or excessive grief adjustment disorders, depression) in the family members of hospice patients is much lower than in similar members of the general population.

There are many other services offered to hospice patients, but the focus remains the same: quality of life, keeping the patient and their loved ones involved in care decisions, excellent symptom control, and maintenance of dignity throughout the continuum of care.

For more information about how palliative care services benefit patients with chronic illnesses, please click here.

This was submitted by Kevin S. Doyle, M.D., medical director of Granite Mountain Home Care and Hospice, who is board-certified in hospice and palliative medicine and family medicine.