WHEN IS THE TIME TO CONSIDER PALLIATIVE AND HOSPICE CARE?

Palliative care and hospice care are similar in that they both provide medical support, pain relief, and symptom management. However, the two have different objectives.

Palliative care is an adjunct care rendered to manage the symptoms of a disease. Palliative care, in general, is rendered to patients who need comfort care at any stage of a disease, whether terminal or chronic. It is another layer of care added to the care that a patient is already receiving from another specialty.

Palliative care can begin even while the patient is receiving curative treatments at different stages of their condition.  There is no expectation that life-prolonging therapies will be avoided in a palliative care program.

Hospice care may be considered when patients no longer benefit from curative treatments

Hospice care is rendered to people at the end of life. Hospice care refers to a team-oriented approach to medical care, pain and symptom management, and emotional and spiritual support according to the preferences and needs of a patient near the end of life.

To qualify for Medicare benefits for hospice care, two physicians must certify that the patient is diagnosed with a terminal illness.  The patient is expected to live for six months or less, following the normal course of the pathological process. Patients or their surrogates chose to stop curative measures and treatments.  The care can be provided at home, in hospitals and nursing homes, and in “in-patient” hospice care facilities.

Patients and family members may start considering hospice care when a patient no longer benefits from curative treatments.  Hospice care is also considered when a patient does not qualify or does not intend to participate in appropriate clinical trials, and there is no evidence that further treatments will be effective. Hospice care allows patients to spend their remaining time as comfortable as possible, most preferably in their homes, having family members participate in their care.

In a community and home hospice care setting, family members typically serve as the primary caregivers. Members of the hospice staff conduct regular visits to assess the patient and provide additional care or services, especially in the management of pain.  An in-patient hospice care facility is available when it becomes difficult to manage the patient at home, or when family members need a respite from caregiving.

Hospice care is integrative. It provides emotional, and spiritual aspects of care to patients and their family during the dying process. Hospice care focuses not so much on the illness, but on patient’s total and holistic well-being and healing. This holistic approach includes maintaining integrity, keeping family relationships, and assuring meaningful life closure through emotional and spiritual support.

 

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References

Vitas Healthcare, Palliative Care vs. Hospice Care “https://www.vitas.com/resources/palliative-care/palliative-care-vs-hospice-care”>https://www.vitas.com/resources/palliative-care/palliative-care-vs-hospice-care

Nancy Berlinger, Bruce Jennings, Susan Wolf, The Hastings Center Guidelines for Decisions on Life- Sustaining Treatment and Care Near the End of Life, revised and expanded second ed. (New York: Oxford University Press, 2013).

Cardinal Parolin: Palliative Care Helps Medicine Rediscover its Vocation, Vatican News, https://www.vaticannews. Feb. 18, 2018. https://www.vaticannews.va/en/vatican-city/news/2018-02/cardinal-parolin-paglia-palliative-care-congress.htmlva.

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