Palliative care, a medical specialty certified in the US since 2006, has long offered comfort-focused care, evolving from the hospice movement. Today, a significant majority of hospitals with over 300 beds incorporate palliative specialists or teams. These professionals collaborate with a patient’s primary physicians to address the multifaceted distress—physical, social, and spiritual—associated with serious illnesses, their treatments, and care decisions.
Defining Palliative Care Programs
Palliative care programs are structured healthcare approaches designed to alleviate suffering from disease or injury. Unlike curative care, which aims to eliminate disease, palliative care programs prioritize patient comfort. The core definition of palliative care remains: to lessen the severity or unpleasantness of a disease or its symptoms without necessarily removing the underlying cause. Palliative care programs effectively “palliate” symptoms, enhancing the patient’s overall quality of life through comprehensive support.
Palliative Care Programs vs. Hospice Care: Key Differences
It’s crucial to distinguish palliative care programs from hospice care, although both focus on symptom management. Hospice care becomes appropriate typically in the last six months of life, as determined by a physician, and is pursued instead of curative treatments. Conversely, palliative care programs offer comfort at any stage of illness, from initial diagnosis onward, and can be delivered alongside curative treatments.
Palliative medicine, and thus palliative care programs, are typically considered in the context of serious illnesses such as chronic pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS, progressive neurological conditions, and cancer. A central aspect of these programs is discussing treatment options and their potential outcomes, both positive and negative. Palliative care programs are designed to empower patients and their families with the information needed to define their care goals and desired results – often referred to as “Goals of Care Discussions.”
Objectives of Palliative Care Programs
Palliative care programs are built around several key objectives aimed at enhancing patient and family well-being:
- Aligning Treatment with Patient Values: Ensuring care decisions reflect the patient’s personal values and preferences.
- Enhancing Quality of Life: Improving the overall quality of life for both the patient and their family members.
- Minimizing Pain and Discomfort: Effectively managing and reducing physical pain and discomfort.
- Addressing Emotional Distress: Alleviating emotional burdens, including anxiety, stress, and depression.
- Supporting Safety and Mobility: Providing assistance with safety concerns, mobility issues, and necessary medical equipment.
- Offering Spiritual Support: Providing spiritual counseling and guidance as needed.
- Empowering Decision-Making: Enabling patients and caregivers to make informed healthcare choices.
The Interdisciplinary Palliative Care Team
Palliative care programs are delivered by a team of professionals, mirroring the interdisciplinary approach seen in hospice care. This team typically includes physicians, nurse practitioners, and registered nurses who conduct clinical evaluations and facilitate care discussions. Social workers and chaplains are frequently integral members, providing emotional and spiritual support.
Benefits of Participating in Palliative Care Programs
Engaging with palliative care programs offers numerous benefits, primarily centered around symptom relief and improved emotional well-being. Physical symptoms like pain, fatigue, appetite loss, nausea, vomiting, and sleep disturbances can be effectively managed through palliative approaches. These may include medications, nutritional adjustments, relaxation techniques such as deep breathing, or complementary therapies like acupuncture, all within the framework of palliative care programs.
For patients and families grappling with the emotional impact of a serious diagnosis, palliative care programs offer crucial support. They address depression, anxiety, and fear through counseling services, support groups, family meetings, and other therapeutic interventions.
Components of Comprehensive Palliative Care Programs
Palliative care programs begin with a thorough assessment to understand the patient’s specific symptoms, needs, and current medications. Adjustments to medication regimens, such as discontinuing drugs causing significant side effects, may be considered as part of a palliative strategy.
Beyond medication, palliative care programs incorporate non-pharmacological approaches like specialized nutrition plans and breathing exercises. Complementary therapies may also be integrated to target specific symptoms and improve patient comfort.
The specifics of each palliative care program are highly individualized, tailored to meet a patient’s unique needs and tolerance for discomfort. Regular communication between the palliative care team and the patient is essential to monitor symptom intensity and adjust treatment plans accordingly. When patients cannot communicate their symptoms, the care team utilizes pain assessment tools and clinical judgment to ensure effective symptom relief.
Duration and Accessibility of Palliative Care Programs
Palliative care programs are accessible at any point during an illness, can last for any duration, and can be delivered alongside curative treatments. While hospice care, which inherently includes palliative care, is often considered in the last six months of life, palliative care programs offer support much earlier in the disease trajectory.
Research indicates that initiating palliative care programs earlier can significantly enhance patient and family satisfaction, improve pain management, and potentially even extend patient survival. Notably, patients who choose to discontinue hospice care can still benefit from ongoing palliative care services.
Discussing Palliative Care Programs with Healthcare Providers
For patients and families facing broader concerns beyond the illness itself, palliative care program teams can provide invaluable assistance. Team members can help navigate financial, legal, employment, transportation, and housing challenges by providing information and connecting individuals with relevant resources. Furthermore, palliative care programs address spiritual needs, respecting diverse cultural and religious backgrounds, or even the absence of religious beliefs.
Palliative care clinicians within these programs are specially trained to listen attentively to patients’ and families’ needs, goals, concerns, and questions. They prioritize patients’ feelings and subjective experiences of pain, guiding conversations to uncover underlying issues and develop comprehensive, patient-centered care plans.
The effectiveness of palliative care programs in enhancing quality of life is well-documented. Effective symptom management and a supportive, listening care environment contribute to patients feeling better and living more fully. Palliative consultations within these programs may also lead to lower healthcare costs by empowering patients to manage their health at home and make informed decisions about treatments that align with their personal goals.
VITAS Approach to Palliative Care Programs
At VITAS, palliative care programs begin with a personalized plan developed by an interdisciplinary team to address each patient’s specific needs. The team supports newly diagnosed patients as well as those managing the effects of curative therapies. VITAS palliative care teams include professionals board-certified in hospice and palliative medicine, alongside chaplains and social workers, offering a holistic approach.
A palliative consultation through VITAS programs provides timely and specific information, helping patients and families understand the benefits of palliative medicine. This consultation also supports physicians and the broader interdisciplinary team in delivering the most appropriate and effective care.
Should a patient’s symptoms worsen beyond the scope of routine palliative care management, VITAS offers 24/7 support to transition patients to higher levels of care. Crisis nurses provide round-the-clock assistance until symptoms are controlled. For severe symptom escalation, VITAS can facilitate transfer to an inpatient hospice unit for intensive symptom management, ensuring patients can return home once stabilized.
