Palliative Care

What is Palliative Care?

Palliative care refers to the specialized care given to persons with advanced and potentially incurable illness such as cancer, end stage kidney disease, liver failure, and Alzheimer’s disease.

The goal of therapy is to keep the patient comfortable and free from pain and the obvious mental stress of a terminal stage disease. It aims to address the symptoms of the disease, adverse effects of drug treatment, psychosocial and spiritual issues the patient and his family may be facing.

Although it is an important aspect of terminal care, it is not necessarily limited to that stage. Palliative care can be provided in a variety of settings including in hospitals, in the patient's own home, in skilled nursing facilities and in the community setting.

Multidisciplinary palliative care teams work with patients and their families to provide symptom management, psycho-social, and spiritual support.

Physicians sometimes refer to palliative care in a sense meaning supportive interventions or therapies without a curative intent, when a cure is considered impossible (as often happens in end-stage cancers). For instance, debulking or reducing tumor size could continue to reduce pain from pressure effect although the operation is no longer going to be curative.

A clearer usage would be palliative, non-curative therapy when cure of illness is not the primary intent, because palliative care can be used simultaneously with curative or aggressive therapies.

Palliative care is also referred to as supportive care, comfort care or symptom management.

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Who Provides Palliative Care?

Palliative care involves the services of a multidisciplinary team of specialists including doctors trained to address issues related to terminal diseases such as pain management and other issues.

A palliative care team includes the following specialists namely -

• A team of doctors such as pain specialists, and cancer specialists
• Specialist nurses
• Social workers
• Registered dieticians
• Psychologists
• Massage therapists
• Physiotherapists
• Chaplains or other religious officials to offer spiritual guidance

Palliative care may be offered in the setting of hospitals, home care agencies, long-term care facilities and cancer centers.

In addition, as mentioned earlier, treatment of disease would also continue side by side as and when appropriate.

What is the Difference between Palliative Care and Hospice Care?

Both palliative and hospice care are based on the underlying principle of providing support and comfort to the patient.

However, the basic difference is that palliative care is initiated during an earlier stage of the illness, when treating physicians feel the disease is fairly advanced.

During palliative care, disease treatment would also continue to be given if the patient is able to tolerate treatment, and other supportive measures to keep the patient comfortable and improve the quality of life are initiated.

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With progression of disease, and when the disease is in a terminal stage i.e. the patient has six months or less to live, the focus shifts to ‘caring’ rather than ‘curing’. Diseasemodifying treatments may be withdrawn and focus shifts primarily to supportive physical and emotional management and curative therapies are withdrawn.

However, hospice care does not necessarily mean giving up. Should the patient’s condition improve, eg. the cancer enters remission, hospice care may be discontinued and active treatment can be re-initiated.

What Aspects of Patient Health does Palliative Care Address?

A serious disease affects not only the person’s physical well-being but also greatly affects one’s morale as well as that of the family with several issues to contend with including the health of a loved one, financial burden of treatment and coping with a sudden increase in responsibilities and even basic questions related to faith and religion.

Physical Issues

Physical problems related to the illness may include the following such as -

• Pain due to pressure on nerve, muscle and body pains
• Sleeping difficulties
• Breathing difficulties
• Loss of appetite, nausea, vomiting

Treatments may include drugs, physiotherapy, occupational therapy, nutritional guidance and parenteral nutrition, nerve blocks for pain relief and integrative treatments.

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Emotional and psychosocial problems

Patients and their families face severe stress during a longstanding life threatening illness that can lead to anxiety, despair, or depression. Family members may have to take on care giving, even if they also have jobs or responsibilities.

Treatments may include counseling, becoming a part of a support group, meetings with close family and friends and referral to a mental health specialist if needed.

Spiritual issues

When people are challenged by illness, they may look for meaning or question their faith. A palliative care team may help patients and families explore their beliefs and values so they can move toward acceptance and peace.

Other problems

Some of the other problems brought on by illness include more basic day to day problems such as financial or job-related problems (loss of income), insurance questions, and legal issues. A palliative care team may help explain complicated medical or insurance forms or help families understand treatment choices, refer families to financial counseling and give advice related to transportation issues and housing facilities.

What are Some Specific Conditions that may Require Palliative Care?

Some of the conditions that require palliative care include the following -

• Cancer
• Heart failure
• Respiratory failure
• Kidney failure
• HIV/AIDS
• ALS (amyotrophic lateral sclerosis)
• Dementia

Palliative Care in Cancer

Cancer can cause various symptoms such as pain, nausea, vomiting, fatigue, constipation, diarrhea, confusion, anxiety, depression and shortness of breath.

The palliative care team not only specializes in alleviating the symptoms of cancer, but they can help with other situations too, such as explaining complicated medical information, or advise about making important treatment decisions.

The palliative care team can ensure that you enjoy the best quality of life possible. They will help in dealing with immediate concerns—like worrying about adverse effects of chemotherapy or radiation, or what outcome of surgery you may have, addressing issues such as loss of your hair and options available, or what will happen if you end treatment.

In addition, they will help with the bigger decisions, like deciding what it is you value most in life or weighing the effects of a specific treatment against those of the disease itself.

Palliative Care in Dementia

Palliative care is as much about helping the family as it is about treating the patient suffering from dementia. Family caregivers often face terrible stress on a 24/7 basis. This is because patients with advanced dementia are totally dependent for activities of daily living and suffer from serious loss of memory lapses and neurological deficits.

Families and caregivers often must face challenging decisions when a patient can no longer eat. Often they have to decide whether artificial feeding (through a tube to the stomach or through a vein) is necessary or not.

Since the disease progresses gradually, caregivers, without even realizing it, begin to overextend themselves and become stressed out and exhausted.

Statistics show that people who are taking care of loved ones with dementia themselves have a much higher risk of falling ill, sometimes even dying, when compared to those not offering such care.

A palliative care team may advice on managing the schedule better, and arrange for paid care givers when family is unable to cope. When home care becomes impossible, they can also arrange hospice care equipped with trained and skilled nursing staff.

Palliative care therefore tries to encompass all aspects of the patient’s health and it addresses the specific problems related to the particular disease and is customised to suit the needs of the patient and his family.

Published reports have shown that patients who received palliative care lived at least three months longer than those who did not.