FAQs

Frequently Asked Questions

  1. What is Palliative Care?
  2. How is Palliative Care different from care for chronic illnesses?
  3. What is Hospice?
  4. What is meant by the term “terminal illness”?
  5. What is Palliative Medicine?
  6. What is Palliative Nursing?
  7. What is Supportive Care?
  8. What are the goals of Palliative Care?
What is Palliative Care?
The verb “palliate” means “to reduce the violence of (a disease)”, or “to moderate the intensity of” a disease process (Webster’s New Collegiate Dictionary, 1979). Root word meanings include “to shield”, “to cloak”, “to conceal”, and “to protect”. Palliative care, then, is properly understood as the means of shielding and protecting patients from the violence of disease, especially the violence of disease at the end of life. The World Health Organization defines palliative care as “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, other symptoms, and of psychological, social, and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families” (World Health Organization, 1990).Palliative care is appropriate when a disease (or diseases) reach the point where cure is no longer a reasonable expectation. When the goals of care shift away from eradicating or combating the underlying disease itself (a.k.a. disease-altering therapies) with the intent to produce cure or remission of that disease, that shift signifies the proper time to institute palliative care. The patient with “an illness man cannot cure” is not to be abandoned by the medical system. Physicians should never utter the phrase “there’s nothing more we can do for you” when describing incurable illness to patients and families. Palliative care goals (e.g., symptom control, preservation of meaning and dignity, emotional and spiritual support) should be pursued with the same intensity and attention to excellence characteristic of the pursuit of curative care goals earlier in the course of illness. How is Palliative Care different from care for chronic illnesses?
In every encounter with a patient, the physician should provide excellent and humane care aimed at maximal relief of suffering. The most effective way to relieve suffering caused by illness is to use interventions which lead to complete resolution of an underlying disease process. Many interventions increase short-term suffering in exchange for cure, long-term relief, or the hope thereof. Such interventions are the focus of most acute medical care. Even in the acute medical setting, where both patient and physician expect complete remission of symptoms or cure to result, every treatment intervention should be tempered with attention to the suffering caused by both disease and treatment. Once the prospect of cure becomes an unreasonable expectation the focus properly shifts to relief or reduction of suffering including the suffering induced by the treatments themselves. This is the palliative approach to medical care.

In the broadest sense, the management of chronic illness (e.g., most types of arthritis) or incurable, eventually fatal illnesses (e.g., Alzheimer’s Disease) is essentially palliative. Some have argued in favor of this point. In its most common and precise use, however, the term “palliative care” describes care provided to patients with limited life expectancy as a result of incurable illness. More specifically, palliative care pursues treatment goals aimed primarily at the reduction of suffering and optimization of quality of life. In this setting, continuation of treatments aimed at cure is not deemed clinically or ethically appropriate since the likely benefits are outweighed the expected risks and side effects (i.e., would produce suffering in excess of potential relief).

What is Hospice?
Hospice, in the ideal, is a system of interdisciplinary palliative care, utilizing the expertise of physicians, nurses, social workers, chaplains, volunteers, and others. In addition to patient care services, care for the family is also provided, including practical assistance with care of the dying patient, maintenance of the home, and bereavement aftercare services. Hospice care and palliative care can be delivered in a patient’s home, in clinics and ambulatory care centers, in general hospitals, in nursing homes and other long-term care settings, and in specialized hospice or palliative medicine units.

In the United States, the term “hospice” has come to represent a system of payment more than a system of care (i.e., a system for funding home-based palliative care for terminally ill patients). As opposed to comprehensive palliative care, hospice care is limited to those services defined within the Medicare Hospice Benefit. This system generally works well, provided that the patient is terminally ill, has a home, has family members capable and willing to provide care for the patient at home, and has symptoms which can be managed outside the hospital setting. When these conditions are not met, the American home hospice care system is not well suited to patient and family needs. Many patients who could benefit from palliative care do not meet disease-specific eligibility criteria for hospice care, cannot have their needs met at home, or are unwilling to accept the restrictions on care and services detailed in the Medicare Hospice Benefit. In other countries where hospice and palliative care are more fully developed, inpatient and residential hospice and palliative care facilities are more common than in the United States.

What is meant by the term “terminal illness”?
Generally, “terminal” illness describes an illness expected to lead to a person’s death in the near future. As defined in the Medicare Hospice Benefit, “terminal illness” is that state where death is expected to occur, as a result of illness, in the next six months or less. Because this definition is derived from hospice eligibility standards, “terminal illness” is commonly equated with hospice care

What is Palliative Medicine?
The term “palliative medicine” describes the art, science, and practice of medicine applied to the care of patients whose disease is not responsive to curative treatment. In other words, palliative medicine describes the physician’s role in palliative care. Some argue that palliative medicine is a medical specialty, while others contend that the principles of palliative care are integral to the effective practice of general medicine.

What is Palliative Nursing?
The term “palliative nursing” describes the art, science, and practice of nursing applied to the care of patients whose disease is not responsive to curative treatment. In other words, palliative nursing describes the nurse’s role in palliative care.

What is Supportive Care?
Supportive Care describes a system of care that is identical to Palliative Care in its interdisciplinary approach and its aim to shield and protect patients from the violence of disease. Like Palliative Care, control of pain, other symptoms, and of psychological, social, and spiritual problems, is paramount and maximal quality of life is the goal. In contrast to Palliative Care, Supportive Care is applied to the care of patients who are still receiving curative (or disease-altering) therapies. Supportive Care is provided in conjunction with these treatments (e.g., chemotherapy, radiation treatments, or surgery for cancer) and is intended to complement these therapies in the pursuit of maximal relief of suffering.

What are the goals of Palliative Care?
The goals of palliative care include non-abandonment, aggressive control of symptoms, maintenance or repair of interpersonal relationships, preservation of a comforting home environment, and attention to important life goals and spiritual and existential concerns. Palliative care has much to offer even when expected survival is measured in months or weeks.

But first, this help must be offered. Every patient dreads hearing the words, “There’s nothing more I can do for you”. Simply letting the patient and family know by word and action that they will not face the end of life alone is a great comfort. Worries about abandonment, helplessness, dependency, preservation of worth and dignity, and undertreated (or untreated) suffering are sources of great worry to terminally ill patients and their families. The tendency to withdraw from dying patients intensifies fear of the dying process. Dying must seem horrible indeed if healthcare professionals cannot bear to attend the patient as it approaches. The converse is certainly true: when the will to stand with the patient is demonstrated, being ready to do what can be done to address suffering as it arises, the process of dying is easier to bear.