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What is Palliative Care? Is palliative care right for me?

There is nothing quite as life-shattering as a life-threatening diagnosis. Yet as the largest generation of the last century enters retirement, chronic diseases such as heart failure, kidney failure, and various forms of cancer—all diseases of the aged—are on the rise; as is the recommendation for palliative care.

That’s exactly what happened to 54 year old Anthony Raymond of Bend, OR who was diagnosed with colon cancer this past summer. At first, it appeared isolated. The doctors thought it an open and shut case. After a routine MRI, however, they discovered spots of cancer on Anthony’s liver. The conversation quickly changed to one of preparing for the worst.

Doctors reassured Anthony by outlining their multi-year treatment plan. First, they explained that they wanted to start him on a course of chemo therapy and immunotherapy. Next, they explained how, depending on how much the tumors in his liver shrank, they planned to operate. It is at this point the conversation turned to palliative care.

Anthony, like many Americans in his situation, immediately associated palliative care with hospice. As his face lost color, he asked his doctor if he thought at this point that he was terminal. The doctor’s reply was a complete surprise.

“No,” the doctor said. “It’s just to keep you comfortable during treatment.”

What is Palliative Care?

Palliative care is most commonly associated with the dying because it is widely used in cancer treatment and in hospices. In practice, palliative care is far more versatile and can be made to serve a wide range of patients. The ultimate goal of palliative care is to improve the quality of life for patients with serious illnesses. Among the serious illnesses it helps with are cancers, certain organ failures, AIDS, Alzheimers, among others.

Palliative care is multidisciplinary, meaning it consists of treatments from different medical fields. Medical professionals with a wide range of expertise work in teams to support the primary care physician to deliver care. All along the way, they pay close attention to how well patients respond. Because it is employed generally for patients with serious illnesses, those patients who are cured of their ailments or in remission move out of this form of care.

Palliative care is not exclusive to the terminally ill.

What does Palliative mean?

The word Palliative comes to the English language by way of the French word palliatif, defined broadly as a treatment that does not act directly on an illness. Palliative care, therefore, is defined as care not intended to treat an illness, but to alleviate suffering and anxiety. The concept is a recent one, and has grown in popularity along side hospice care, a movement begun in the 1960’s by British nurse Cicely Saunders.

What is the difference between palliative care and hospice care?

The reason palliative care has been closely associated with hospice care over the last half century is because hospices offer palliative services as part of their care plan. The difference between the two has to do with for whom the care is intended. Hospice care treats the terminally ill, and offers palliative care without any hope of the patient’s recovery. In contrast, Palliative care is offered to any patient of any illness who may need help coping with the pain and anxiety of having a serious illness and its treatment.

When hospices began springing up in the late 1960’s and early 1970’s, there was no difference between hospice care and palliative care. Hospices offered palliation to ease the discomfort of those with terminal illness as part of their mission to offer compassionate care for the dying. It was not until much later, in the 1990’s, that the broader benefits of palliative care caught the attention of the medical community. As soon as other medical disciplines began to make use of palliation for the treatment of a much wider range of patients, palliative care as a sub-discipline of its own began to take form.

In 2006, palliative care was recognized as a board certified sub-speciality of internal medicine. This has encouraged a general proliferation of its use across all medical disciplines, including oncology, cardiology, nephrology, even home health care.

What should I expect during care?

Palliative care takes a holistic approach to treatment and focuses on four core reliefs: physical, psychological, social, and spiritual. Not all patients will need care for all four. In fact, most only receive care for one or two of the core reliefs. It is up to the patient and their family to decide on what is needed.

Physical relief is intended to relieve suffering in the form of pain and discomfort as a result of an illness or treatment.

Physiological relief is intended to relieve any distressing symptoms associated with physiological changes such as nausea and breathlessness.

Social relief is intended for both patients and their families to help cope with the burden of a serious illness.

Spiritual relief is intended to help patients cope on a deeper level with the illness they face, both in terms of life changes and with the prospect of dying.

Is palliative care right for me?

This is a crucial question for those facing a serious illness. As with the case of Mr. Anthony Raymond, the topic may spring up sooner than expected, and perhaps even out of the blue. It is important to understand that a doctor who brings up this subject is in no way alluding to your imminent demise. A recommendation for such services simply underscores a physician’s desire to keep you comfortable and improve your quality of life when facing a serious illness.

The National Institute of Nursing Research recommends the following:

Many adults and children living with illnesses such as cancer, heart disease, lung disease, kidney failure, AIDS and cystic fibrosis, among others, experience physical symptoms and emotional distress related to their diseases. Sometimes these symptoms are related to the medical treatments they are receiving.

You may want to consider palliative care if you or your loved one:

– Suffers from pain or other symptoms due to ANY serious illness.

– Experiences physical or emotional pain that is NOT under control. 

– Needs help understanding your situation and coordinating your care.

It’s never too early to start palliative care. In fact, palliative care occurs at the same time as all other treatments for your illness and does not depend upon the course of your disease. There is no reason to wait. Serious illnesses and their treatments can cause exhaustion, anxiety and depression. Palliative care teams understand that pain and other symptoms affect your quality of life and can leave you lacking the energy or motivation to pursue the things you enjoy. They also know that the stress of what you’re going through can have a big impact on your family. And they can assist you and your loved ones as you cope with the difficult experience.