Palliative care is a new medical subspecialty that is making its
way into hospitals around the country. Many physicians are
unsure when to refer to palliative care.
Which of the following patients qualifies for palliative care?
What is palliative care and what does it do?
- A 93-year-old man with a history of dementia and medical problems is admitted with obtundation. CT scanning reveals a hemorrhagic stroke. His family refuses neurosurgical intervention and is unable to agree on treatment.
- A 72-year-old man is admitted for the fourth time in three months with exacerbation of congestive heart failure. He has chronic dyspnea, insomnia, pain from diabetic neuropathy and nausea from gastroparesis. His goal is to ?fight to the end.?
- A 65-year-old woman has been in the ICU for three weeks with cirrhosis, sepsis, and respiratory and renal failure. She has been declining despite aggressive therapy, but remains full code.
- A 37-year-old man with cancer is admitted for nausea and vomiting related to therapy that has the potential to cure the malignancy if he can complete the treatments.
Palliative care is interdisciplinary care that works to relieve suffering and improve quality of life for patients with advanced illness and their families. Simply put, palliative care aims to relieve any kind of suffering, in any patient, in any family, in any clinical situation.
Suffering can take many forms, from physical symptoms to existential distress, from emotional pain to family conflict. Palliative care works first to improve symptom control. Studies have shown that palliative care involvement reduces pain and also relieves nonpain symptoms, such as nausea, breathlessness, constipation, delirium and insomnia. A patient whose symptoms are closely monitored and treated is more able to complete curative and life-prolonging therapy or participate in life-closure activities, when comfort is the goal.
Once symptoms are improved, palliative care can help address other vital needs. Goals can be identified and steps initiated to help reach those goals. Patient and family questions can be answered. Education about therapies or prognosis or the dying process can be provided. Difficult decisions regarding code status, further aggressive therapy or feeding tubes can be made. Family meetings can be facilitated and communication enhanced when multiple physicians are involved in the patient's care. Spiritual and emotional struggles can be explored. When necessary, end-of-life care can be provided in the hospital or through a transition home with hospice support.