As Americans with chronic illness are living longer, more patients and families are faced with difficult questions about quality end-of-life care and what makes life worth living. As November is National Hospice and Palliative Care Month, it is important to bring this critical conversation to the forefront and encourage nurses who are on the frontline working with patients and families to be aware of the difference between palliative and hospice care, when they should be discussed and implemented, and the critical need for both services.
Defining Palliative and Hospice Care
There has been a shift in thought over the last forty years, with the recognition that extending life isn’t necessarily more important than quality of life, and palliative and hospice care have helped support this critical gap. However, confusion exists between the two, with most people familiar with hospice care but unsure about the term palliative care. While the disciplines may offer overlapping benefits at times, palliative and hospice care are distinct.
Palliative care is a specialized area of medicine that focuses on quality of life and relieving the symptoms of patients with serious chronic illnesses, such as heart and lung disease. Palliative care providers address the whole patient – spiritually, emotionally, and physically – and look at the big picture of how patients’ illnesses can affect their lives as they know it. Patients can continue to receive aggressive curative medical treatments, such as chemotherapy or dialysis, while receiving palliative care. These specialists help begin a dialogue between patients and their families about how to best live with disease or illness, discuss the need for advanced care planning, and also assist in making sure that families understand the patients’ wishes. They do not replace any of a patient’s health care team, but instead add a layer of support to improve their overall well-being. Patients seeking to improve their quality of life at any stage of their disease, can seek the assistance of a palliative care specialist, and there is no time limit for when or how long a patient can receive palliative care.
While also palliative in nature, modern day U.S. hospice care began in the mid-1970s, and is a type of specialized care for individuals who are certified by a physician as having a terminal illness and are expected to live for six months or less. Patients seeking hospice care have expressed a wish to have symptom management as well as emotional and spiritual support. The focus of hospice is caring, not curing, and is aimed at relieving pain and allowing a patient to die where and how they want. It can be delivered in a patient’s home, a long-term care facility, or a free-standing hospice home. The hospice team creates an individualized plan of care aimed at alleviating a patient’s suffering, allowing them to pass away with peace and dignity, while also providing support for the patient’s family.
Introducing Palliative Care to Patients
Palliative care should be introduced early in a chronic disease. Often it is added to the health care team too late in an illness trajectory, when patients are approaching or eligible for hospice care, when multiple hospitalizations have occurred, or when they have had a dramatic decline in their health. Like many medical issues, early intervention is imperative, and adding a palliative care specialist early helps patients have a sense of empowerment in making decisions about their life and health. Research shows that early involvement of palliative care specialists can actually help patients live longer.
It’s also critical that nurses and doctors are aware of the benefits of palliative and hospice care, and that they present the added health care layer in a positive way to patients, at the appropriate time for them to reap the maximum benefits of these important specialties. Doctors and nurses need to have confidence in their knowledge of palliative and hospice care, and understand that patients don’t need to choose between the two. They both have an important place in the medical field.
With the average life span in the United States now nearly 80 years old, and medicine continuing to advance, quality of life and end-of-life care will continue to be significant issues and discussions facing our population. Knowing when and how to incorporate this layer of support into your patients’ health care plan will help you provide the best possible care for your patients.