This post was written by Dona Uncheselu, MD, PPG – Palliative Care.
I first discovered palliative care when I was training in geriatrics. I was working with Dr. Mohs, a geriatrician specialized in palliative care. I vividly remember our first patient—I evaluated her and came up with what I thought was the best recommendations based on each medical problem this 91-year-old woman had. When Dr. Mohs and I then visited the patient together, I was surprised to hear Dr. Mohs ask our patient questions like, “What matters most to you?” and “What does it mean for you to have a good quality of life?” No other physician I had worked with inquired about these topics before. Our patient was also surprised and happily answered the questions. With this information straight from the patient, Dr. Mohs made new recommendations that aligned with the patient’s goals and values.
Seeing how much the plan of care pleased the patient, I decided to specialize in palliative care after completing my geriatrics fellowship, because providing the best care to our patients is important to me.
What is palliative care?
Palliative care is specialized medical care that focuses on relieving symptoms, side effects and stress from a serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a specially trained team of doctors, nurses and other specialists who work with the patient, their loved ones and their other doctors to provide an extra layer of support.
Palliative care teams often help patients manage symptoms and side effects of treatments including pain, shortness of breath, nausea, constipation, fatigue, depression, anxiety, insomnia and loss of appetite. The palliative care team will also ensure that medical care is aligned with the patient’s goals and treatment preferences by aligning all of the patient’s specialists on the same page.
Is palliative care end-of-life care?
A common misconception is that palliative care is only for end of life, but it’s appropriate at any age and at any stage in a serious illness, and is often provided alongside curative treatment. Palliative care is based on the needs of the patient and not the prognosis.
Where can you receive palliative care?
Palliative care can be provided in the hospital, in outpatient palliative care clinics or even in nursing homes.
A care team for a variety of conditions
Increasingly, palliative care specialists are becoming involved in the care of patients diagnosed with cancer. However, most palliative care teams work with patients who have multiple chronic medical problems (typically three or more) that interfere with their quality of life, such as:
- COPD
- Congestive heart failure
- Diabetes
- Chronic kidney disease stage 4
- Alzheimer’s disease or dementia
- Parkinson’s disease
- Amyotrophic Lateral Sclerosis (ALS)
These conditions often require patients to take multiple medications, follow different diets and see multiple specialists, which can be overwhelming for patients and families.
Support for patients and their caregivers
Palliative care teams seek to support not only the patient, but their loved ones as well. This is why, in addition to doctors and nurses, palliative care teams also include social workers and chaplains. By understanding the patient’s goals and what it means to them to have good quality of life, the palliative care team helps patients have open communication with their families and caregivers. While the focus of our care is the patient, palliative care will also ensure that the family are supported and that their caregiving burden is addressed.
A constant presence throughout the journey
The palliative care team walks alongside the patient and family, providing an extra layer of help and support as they navigate a complicated healthcare journey. As a patient’s condition may change over time, the palliative care team can also assist with the transition of care whenever needed.
For patients interested in completing advanced directive documents, like a Physician Orders for Scope of Treatment (POST) form or establishing a healthcare representative, the palliative care team can help with those as well.
To inquire about palliative care for a loved one in the hospital, ask the patient, bedside nurse and/or their doctor if they could benefit from consulting with these specialty team members. For a palliative care clinic referral, ask your primary care provider or specialist to make a referral to the Outpatient Palliative Care Clinic.
