An article in the New York Times tells the story of an elderly woman, Mrs. Chin, who has terminal cancer. All curative treatment options have been exhausted, and doctors suggested more than once to her son that palliative care could ease some of the pain and depression she was experiencing, but her son refused. In his mind "palliative care" meant "they're giving up on her". This is not an uncommon reaction; but it's based on a mistaken assumption.
Fortunately for Mrs. Chin, her son eventually relented and as a result her quality of life improved. She has less pain and discomfort, a social worker helps the family deal with home care schedules and insurance, and nurses are available to answer questions any time, day or night.
The sub-specialty of palliative medicine is a relatively new development. While it has grown in the last 15 years, it has been an approved medical specialty only since 2007. According to the National Hospice and Palliative Care organization, palliative medicine is specialized care for patients (and their families) of any age at any stage in a serious illness. Palliative care can be provided along with curative treatment – a patient does not need to have a terminal diagnosis to qualify for or benefit from palliative care.
On the other hand, palliative care can also help ease pain, stress and depression for patients who do have a terminal diagnosis and who have either exhausted all curative treatment possibilities, or who have chosen to stop all such efforts.
Hospice care is “end of life” care. Usually a patient admitted to hospice has a life expectancy of six months or less. Through hospice programs a team of healthcare professionals provide medical, psychological and spiritual support to terminally ill patients and their families. The care may take place at a hospice center, in the family home, in a hospital or in a skilled nursing facility. Palliative care – the effort to ease physical and emotional distress – is an important component of the hospice model, the main difference being that hospice programs focus on palliative/comfort care rather than combatting disease, while palliative care may also be used as needed for patients who are undergoing curative treatment, with or without a terminal diagnosis.
According to the NY Times article, a study at Massachusetts General Hospital found that patients with metastatic lung cancer who got early palliative care scored much higher on quality of life measures and had less depression than those receiving standard care. They were also less likely to get aggressive end of life treatment like chemotherapy in the final weeks of their lives, but also survived several months longer than those not getting palliative care early on.
Most people express a desire to die at home, or at least not to die in a hospital. A study at the University of California, San Francisco found that of nearly 1,000 patients who died, those who had palliative care for 90 days or more were less likely to have late-life hospitalizations, less likely to visit emergency rooms and less likely to end up in an intensive care unit than those who got the care later.
Palliative care can ease pain and distress for patients dealing with serious illness whether they are getting other treatment or not and whether the illness is terminal or not. Hospice provides physical, emotional and spiritual support for patients with a life expectancy of six months or less and for their families.
1. New York Times, Feb. 16, 2016; “In Palliative Care Comfort is the Top Priority”, by Paula Span.
3. www.nhpco.org National Hospice and Palliative Care Organization.