DEFINITION

Palliative care is both a philosophy of care and an organized, highly structured system for delivering care. The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies (National Consensus Project for Quality Palliative Care [NCPQPC], 2004). Palliative care expands traditional disease-model medical treatments to include the goals of enhancing quality of life for the patient and family, optimizing function, helping with decision making, and providing opportunities for personal growth. It can be delivered concurrently with life-prolonging care or as the main focus of care.

Palliative care can and should be initiated at the diagnosis of a serious life-threatening or chronic, progressive illness and continued throughout the course of the illness across all care settings. As illustrated in the figure on page 438, palliative care is started along with life-prolonging therapies at the initial diagnosis of a life-threatening illness. As the disease progresses, there is a greater and greater emphasis on palliative interventions versus life-prolonging interventions. Hospice care is the part of the palliative care continuum when the emphasis is no longer on life prolongation, but primarily on comfort. In the United States, this is often defined as the last 6 months of life and is based on the eligibility requirements for hospice benefits under Medicare.

The NCPQPC defines palliative care as “medical care provided by an interdisciplinary team…focused on the relief of suffering and support for the best possible quality of life for patients facing serious life-threatening illness, and their families. It aims to identify and address the physical, psychological, spiritual, and practical burdens of illness” (NCPQPC, 2004). Palliative care is distinguished from routine symptom management by the following:

See the box on page 438 for a summary of the practice guidelines outlined by the NCPQCP.

PALLIATIVE CARE IN PERSONS WITH CANCER

Every patient diagnosed with cancer needs good symptom management from the time of diagnosis. Patients whose cancer is diagnosed at an advanced stage or whose cancer progresses during or after treatment are likely to have multiple physical, psychological, emotional, or spiritual concerns. The expertise of the palliative interdisciplinary team can be especially helpful at this time.

In general, the following patient populations are appropriate for palliative care:

MODELS OF PALLIATIVE CARE DELIVERY

Palliative care services are most effective when integrated into the care setting. Various models are used to facilitate access to the expertise of the palliative care team. These models include one or a combination of some of the following:

HOSPICE PALLIATIVE CARE

The figure on page 438 illustrates that hospice care is the part of the palliative care continuum when life-prolonging therapies are no longer providing benefit. The focus of care is on comfort and quality of living by affirming life and viewing dying as a normal process. Services provided by the hospice interdisciplinary team include pain and symptom management, psychosocial and spiritual support, assistance and support with direct caregiving, and bereavement care for both the patient and family. The practice guidelines outlined by the NCPQPC (see box on right) also apply to the organized, comprehensive services available through hospice programs.

Palliative care’s place in the course of illness. From National Consensus Project for Quality Palliative Care. (2004). Clinical practice guidelines for quality palliative care. Retrieved February 5, 2007, from http://www.nationalconsensusproject.org.

Stay updated, free articles. Join our Telegram channel

Join