Palliative and Hospice Care

Palliative care can be defined as an approach that improves the quality of life of patients and their families. 

It is concerned with the prevention and relief of suffering through the early identification and treatment of pain and other physical, psychosocial, and spiritual concerns (Sepulveda, C., et al., 2002). 

Palliative care can be initiated regardless of the stage of the disease or the need for other therapies.  It enhances quality of life for patients and family members, helping with decision-making, and providing opportunities for personal growth.

Palliative is not a separate entity of care. It can be rendered along with life-prolonging treatment OR as the main focus of care.  Thus, medical care is provided by an interdisciplinary team, which identifies and addresses the physical, psychological, spiritual, and practical burdens of illness.

The word “palliative” comes from the Latin word pallium (cloak/cover). When a patient receives palliative care, the intent is to “cover-up” the pain and other debilitating symptoms so that they are reduced or completely “covered” and no longer visible.  

Hospice care supports the patient through the dying process and the surviving family through the dying and bereavement processes.* 

It provides comprehensive medical and supportive services across a variety of settings and is based on the idea that dying is a part of the normal life cycle.  Hospice care can be given at home, in residential facilities, hospitals, nursing facilities, and even in prisons.

In the late 1960’s, modern programs to care for the dying were organized (St. Christopher’s in London was the most notable, founded by Dame Cicely Saunders).  The word “hospice,” borrowed from the Middle Ages, was used to designate way-stations for pilgrims on their way to the Holy Land.  Dame Saunders viewed life as a journey, and just as pilgrims needed a place of support to be able to finish a journey, those near the end of their life’s journey need support in order to complete their passage well. 

Because hospice takes care of the terminally ill, it quickly becomes associated with death.   In some cultures, coming under the care of a hospice program has been seen as a “death sentence,” leading many patients/families to resist admission to hospice.

*(Egan-City & Labyak, 2010)

Both palliative care and hospice care provide comfort. But palliative care can begin at the moment of disease diagnosis, or at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness. However, treatment for symptoms is still provided.

Technically, hospice care is offered only when the person is expected to live 6 months or less.   

When a patient is diagnosed with a terminal illness for which therapeutic management is deemed futile, hospice care ensues. Hospice care does not aim to prolong life. Instead, the main goal is to make sure that a patient’s quality of life is maximized. It offers comfort care that is holistic, taking into account a person’s physical, emotional, mental, social, and spiritual well-being.

One of the misconceptions about hospice care is that it hastens death. There is no truth to this. In hospice care, although death is considered as a natural stage in a person’s existence, it is morally wrong to deliberately hasten it. In case treatment results death, the ethical principle of double effect, where the intention to do good takes precedence over a bad outcome, sustains the decision to provide symptom alleviation.

The process of death is not considered as a failure among hospice practitioners. Instead, the success of treatment rests upon the satisfaction of patients and their families. For instance, even if a patient dies, if a physician is able to facilitate carrying out the final plans of the patient through constant communication and pain alleviation, the actual death of a patient turns out to be the culmination of a job well done. A physician who also fosters closer family ties and bridges emotional gaps among the patient’s loved ones will also find a lot of satisfaction with this eventuality.

A successful hospice program also entails a team approach to patient management. While the physician, under the direction of the patient or the patient’s proxy decision maker, remains the primary source of medical knowledge, the contribution of the nurses, caregivers, and social health workers remain crucial. Spiritual support from a chaplain or a religious leader also makes a difference in creating a treatment plan.

What are the benefits of hospice care at home?

• The patient stays in a familiar environment close to family and friends, who can visit anytime.

• Personalized care and support can be provided by family members and care teams.

• There is a perceived sense of dignity for patients when they are being treated at home.

• Most patients feel respected with regards to their wishes when they are in a familiar environment.

• Financial burdens are lessened.

• There is more time to provide family counseling.

How does palliative care reduce cost?

Hospitals that introduce palliative care for very sick patients have reduced hospital stays and lower costs, according to a study published in JAMA Internal Medicine.  Pooled data from six prior studies involving over 130,000 adults admitted to hospitals in the United States between 2001 and 2015 found that palliative care results in reduced hospital stays and associated cost savings, particularly for patients with the most complex conditions. The study found that hospitals saved on average US $3,237 per patient, over the course of a hospital stay, when palliative care was added to their routine care as compared to those who didn’t receive palliative care.  Savings were greatest for patients with the highest number of co-existing illnesses.

What Does Palliative Care Include?

Palliative care can address these effects of a person's illness:

●     Pain

●     Trouble sleeping

●     Shortness of breath

●     Loss of appetite / Inability to swallow food

●     Bed sores and pressure ulcers

●     Extremity weakness

●     Depression and anxiety

●     Behavioral changes

●     Lack of financial resources 

●     Lack of emotional and spiritual support

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