31 Mar Ask Alice April 2022

ASK ALICE

This Month’s Topic: Palliative Care

ASK ALICE

Dear Alice,

My favorite cousin was just diagnosed with a serious illness.  Fortunately, the long term prognosis is good, and with treatment she is expected to recover.  For now, however, she is in quite a bit of pain, and her treatment is actually adding to her discomfort.  Her primary doctor suggested bringing in palliative care, which my cousin has agreed to do. 

I’m glad she has hope for relief, of course, but I’m a little confused.  I always thought palliative care was just part of hospice care, to provide relief from pain and discomfort for those nearing the end of their lives.  Can you explain how palliative care differs from hospice care?

             Thanks, 

                   Confused about Palliative Care

Dear Confused,

This is an excellent question, and one that a lot of people have.

Palliative care is medical care geared toward symptom management and comfort, at any stage of a patient’s life or any step of a serious illness’s progression.

I understand the confusion between palliative care and hospice care because they share a common purpose –  to alleviate or mitigate a patient’s symptoms, make them feel better, and improve their quality of life.  And there is a significant overlap between palliative care and hospice care, as palliative care generally will be part of the services available for hospice patients.  However, medical practitioners are increasingly recognizing that palliative care may also be valuable for patients receiving curative treatments for serious illnesses from which they are expected to recover (or at least from which there is a significant chance of recovery), and that it should be made available to them as well.  In other words, to the extent the resources are available, palliative care can go hand-in-hand with curative treatment just as it can go hand-in-hand with hospice care.  Indeed, palliative care often supports the curative treatment by helping the patient get through the curative treatment with a minimum of symptoms.

This should clear up the question of who may benefit from palliative care:  anyone with a serious or life-limiting illness whose quality of life is being negatively impacted by their illness, its treatment, or both.   Now let’s talk a little about how it optimally works.

Palliative care will optimally begin with a conversation similar to the conversation we have when we begin the advance care planning process  (or any other patient-centered care process, for that matter), except that it can be specifically geared to the patient’s current situation and options.  The palliative care team needs to really get to know the patient and their values in order to know what to recommend.  How much does the patient know and understand about their illness, treatment, and prognosis; and how much do they want to know and understand about them?  What does “quality of life” mean to them specifically?  What activities and abilities are most important to them, and what losses or situations do they they fear the most?  What are their goals, and what outcomes would be simply unacceptable?

It is apparent that palliative care involves a lot of talking and relatively few procedures, and this is why many hospitals, especially in rural and other underserved areas, don’t use palliative care teams more.  As a palliative care specialist explained to Taking Steps Brattleboro volunteers last fall, it is hard to get Medicare reimbursement for talking, so it’s almost impossible for a palliative care team to bill enough to support themselves.  Fortunately, however, more and more hospital administrators are recognizing that the positive outcomes fostered by the palliative care team can be good not only for the suffering individuals but also for the bottom line of the hospital and the health system as a whole.  Accordingly, we are starting to see more and more hospitals adding, developing,  and supporting palliative care doctors and teams, at least if they have the resources available to do so.

I hope this helps clear up your confusion.

Best wishes,   Alice   

Please contact Ruth Nangeroni, Taking Steps Brattleboro Coordinator, 802-257-0775, ext. 101, or ruth.nangeroni@brattleborohospice.org, for information about Advance Care Planning.

Till next month, folks.  Please send your questions to Alice via info@brattleborohospice.org.