Palliative care is specialized medical treatment for people living with a severe illness, focused on providing relief from symptoms while improving their quality of life. Dona Uncheselu, MD, PPG – Palliative Care, expands on this innovative approach to patient care, how it supplements medical treatment, and the unique support it offers both patients and families.
What are the differences between palliative care and hospice?
Both approaches can benefit patients approaching the end of life or who have a chronic illness that cannot be cured and continues to progress over time. With palliative care, patients continue to receive treatment for their condition. It works in tandem with disease-specific treatment while focusing on controlling symptoms, such as pain, and preserving a person’s quality of life for as long as possible. Hospice care focuses on patients at the end of their lives. Treatment for their illness is discontinued, so the goal and emphasis is on the quality of life, ensuring both peace and dignity as they say goodbye.
How long has palliative care been around?
Palliative care is relatively new. Dame Cicely Saunders founded the first modern hospice program in London in 1976, and was considered the mother of palliative care. But it didn’t just happen all at once. Remember, hospice care focuses on helping patients at the end of their lives, keeping them comfortable, and allowing them to live their best for as long as possible. That’s where the palliative philosophy started to gain momentum. You see, over time, patients and families began to ask why. Why couldn’t they feel comfortable before they reached their end of life? Why couldn’t they feel good while continuing with treatment? From these notions, the palliative care approach began.
Many assume palliative care leads to hospice or an end-of-life scenario, but is that always the case?
No, not necessarily. We often have patients who receive palliative care to continue their disease-specific treatment. A great example of this would be cancer patients. You will frequently see a palliative medicine provider, physician or nurse practitioner work alongside the oncologist to continue their course of treatment comfortably. However, providers also utilize palliative care when caring for patients with other medical problems, such as congestive heart failure or a neurological disorder that progresses over time like ALS or Parkinson’s. Having a palliative care provider present during these times can be highly beneficial. They help oversee and coordinate a patient’s individualized care, considering what their wants, needs, goals and treatment preferences might be as they progress. A palliative care provider is there to help advocate for the patient and their family.
How do you and other palliative providers assist caregivers or family members of a patient?
Fortunately, as a palliative provider, I work with an amazing team of people, and collectively we strive to cloak or surround patients, caregivers and family members with as much support as possible to meet their needs. We have social workers who can connect individuals with the resources available in the community, including counseling. We have a chaplaincy program as part of our team as well. They help provide spiritual and emotional support because we know faith plays a vital role in the healing process for many. We also work very closely with nurses and nurse practitioners. It’s always a team effort where we try to address and treat the medical problem and the needs of the whole patient and their loved ones.
Where does palliative care typically take place?
Palliative care can occur in various places. We can provide it in the home, a patient-familiar environment, the hospital, nursing home or even a palliative care clinic where patients can come to see us. It can take place wherever a patient is in need, and, ultimately, that’s our goal, to meet the patient wherever they are in that moment.
Is there an age limit as to who can receive palliative care treatment?
No, there’s no minimum age requirement for receiving palliative care. We can see patients as young as newborns, helping them get healthy and strong to be able to go home with their parents, all the way to older adults who require assistance with symptom control as they receive disease-specific treatments.
How does a patient or caregiver know when it's time to look into hospice or palliative care?
It depends on the patient and their situation, but I always recommend starting the discussion with your primary care provider or specialist (oncologist, cardiologist, etc.) who’s providing care. Then, the physician will make a referral to us if appropriate.
Should people include palliative care in their advanced care planning?
Yes, we always encourage our patients to do this, and we can even help them complete any advanced care planning or advanced directive documents. This allows patients and families to have a conversation about what their goals are and what their treatment preferences might be when they approach these stages in life. We recommend putting these wants and needs in a living will along with designating who they want to hold their power of attorney or act as their healthcare representative when the time comes.
