Palliative or Hospice Care During and End of Life

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A woman being treated with docetaxel chemotherapy for breast cancer.  Cold mittens and wine coolers are placed on her hands and feet to prevent deleterious effects on the nails.

 

Palliative care (also called palliative medicine and comfort care) is an area of healthcare that focuses on relieving and preventing the 1) ___ of patients. Unlike hospice care, palliative care is appropriate for patients in all disease stages, including those undergoing treatment for curable illnesses and those living with chronic diseases, as well as patients who are nearing the end of life. While palliative care may seem to offer a broad range of services, the goals of palliative treatment are concrete: relief from suffering, treatment of pain and other distressing symptoms, psychological and spiritual care, a support system to help the individual live as actively as possible and a support system to sustain and rehabilitate the individual’s family.

 

Palliative medicine utilizes a multidisciplinary approach to patient care, relying on input from physicians, pharmacists, nurses, chaplains, social workers, psychologists and other allied health professionals in formulating a plan of care to relieve suffering in all areas of a patient’s 2) ___. This multidisciplinary approach allows the palliative care team to address physical, emotional, spiritual and social concerns that arise with advanced illness.

 

Medications and treatments are said to have a palliative effect if they relieve 3) ___ without having a curative effect on the underlying disease or cause. This can include treating nausea related to chemotherapy or something as simple as morphine to treat the pain of broken leg or ibuprofen to treat aching related to an influenza (flu) infection. Although the concept of palliative care is not new, most physicians have traditionally concentrated on trying to 4) ___ patients. Treatments for the alleviation of symptoms were viewed as hazardous and seen as inviting addiction and other unwanted side effects. The focus on a person’s quality of life has increased greatly since the 1990s. In the United States today, 55% of hospitals with more than 100 beds offer a 5) ___-care program, and nearly one-fifth of community hospitals have palliative-care programs.A relatively recent development is the palliative-care team, a dedicated health care team that is entirely geared toward palliative treatment. Immediate palliative care is indicated for patients with any serious illness and who have physical, psychological, social, or spiritual distress as a result of the treatment they are seeking or receiving.

 

Palliative care increases comfort by lessening 6) ___, controlling symptoms, and lessening stress for the patient and family, and should not be delayed when it is indicated. Palliative care is not reserved for patients in end-of-life care and can increase quality of life and lengthen the patient’s life. If palliative care is indicated for a person in an emergency department, then that care should begin in the emergency department immediately and with referral to additional palliative care services. 7) ___ care physicians have a unique and critical position to begin discussions with patients and caregivers about palliative care and hospice services as they see persons in difficult times of life.

 

Palliative care is a term derived from Latin palliare, “to cloak”. It refers to specialized medical care for people with serious illnesses. It is focused on providing patients with relief from the symptoms, pain and stress of a serious illness – whatever the prognosis. The goal is to improve quality of life for both the patient and the family as they are the central system for care. Palliative care is provided by a team of doctors, nurses and other specialists who work together with a patient’s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

 

A World Health Organization statement describes palliative care as “an approach that improves the quality of life of patients and their 8) ___ facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” More generally, however, the term “palliative care” may refer to any care that alleviates symptoms, whether or not there is hope of a cure by other means; thus, palliative treatments may be used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherapy.

 

The term “palliative care” is increasingly used with regard to diseases other than cancer such as chronic, progressive pulmonary disorders, renal disease, chronic heart failure, HIV/AIDS and progressive neurological conditions. In addition, the rapidly growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness.

 

Palliative care:

1. provides relief from pain, shortness of breath, nausea and other distressing symptoms;

2. affirms life and regards dying as a normal process;

3. intends neither to hasten nor to postpone 9) ___;

4. integrates the psychological and spiritual aspects of patient care;

5. offers a support system to help patients live as actively as possible;

6. offers a support system to help the family cope;

7. uses a team approach to address the needs of patients and their families;

8. will enhance quality of life;

9. is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy.

 

 

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Florence Sophie Schorske (1917-2008), Dean of the Yale School of Nursing and Pioneered the American Hospice movement

 

In the United States, a distinction may be made between palliative care and hospice care. Hospice services and palliative care programs share similar goals of providing symptom relief and pain management.Palliative care services can be offered to any patient without restriction to disease or prognosis, and can be appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression. 10) ___ care under the Medicare Hospice Benefit, however, requires that two physicians certify that a patient has less than six months to live if the disease follows its usual course. This does not mean, though, that if a patient is still living after six months in hospice he or she will be discharged from the service. The philosophy and multi-disciplinary team approach are similar with hospice and palliative care, and indeed the training programs and many organizations provide both. The biggest difference between hospice and palliative care is the patient: where they are in their illness especially related to prognosis and their goals/wishes regarding curative treatment.

 

Outside the United States there is generally no such division of terminology or funding, and all such care with a primarily palliative focus, whether or not for patients with terminal illness, is usually referred to as palliative care, without restriction. Outside the United States the term hospice usually refers to a building or institution which specializes in palliative care, rather than to a particular stage of care progression. Such institutions may predominantly specialize in providing care in an end-of-life setting; but they may also be available for patients with other specific palliative care needs.

 

 

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Hospice Saint Vincent de Paul, Jerusalem

 

ANSWERS: 1) suffering; 2) life; 3) symptoms; 4) cure; 5) palliative; 6) pain; 7) Emergency; 8) families; 9) death; 10) Hospice

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