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Palliative care
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Jump to: navigation, search Palliative care (from Latin palliare, to cloak) is an form of medical care or treatment that concentrates on reducing the severit of disease s mptoms, rather than providing a cure! "he goal is to prevent and relieve suffering and to improve #ualit of life for people facing serious, comple$ illness! %on&hospice palliative care is not dependent on prognosis and is offered in con'unction with curative and all other appropriate forms of medical treatment! (t should not )e confused with hospice care which delivers palliative care to those at the end of life! (n the *+ this distinction is not operative, hospices and non hospice )ased palliative care teams )oth provide care to those with life limiting illness at an stage of their disease! (See -Histor - and -.ractice- )elow for additional information on hospice and hospice care!)

Contents
[hide] / 0oncept 1 0larification 2 3oals 4 Histor 5 .ractice 6 7ealing with distress 8 See also 9 :ootnotes ; <$ternal links

[edit] Concept
"he term -palliative care- ma )e used generall to refer to an care that alleviates s mptoms, even if there is hope of a cure ) other means, thus, a recent =H> statement[/] calls palliative care -an approach that improves the #ualit of life of patients and their families facing the pro)lems associated with life&threatening illness!- (n some cases, palliative treatments ma )e used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherap !

"he term -palliative care- is increasingl used with regard to diseases other than cancer, such as chronic, progressive pulmonar disorders, renal disease, chronic heart failure or progressive neurological conditions! (n addition, the rapidl &growing field of pediatric palliative care has clearl shown the need for services geared specificall for children with serious illness! "hough the concept of palliative care is not new, most ph sicians have traditionall concentrated on aggressivel tr ing to cure patients! ?vaila)le treatments for alleviation of s mptoms were viewed as ha@ardous and seen as inviting addiction and other unwanted side effects![1] >ver the past twent ears, the focus on a patientAs #ualit of life has gained su)stantial ground! "oda in the *nited States, 55B of *!S! hospitals with over /CC )eds offer a palliative care program[2] and nearl one&fifth of communit hospitals have palliative care programs![4] ? relativel recent development is the concept of a dedicated health care team that is entirel geared toward palliative treatment, called a palliative care team!

[edit] Clarification
"here is often confusion )etween the terms hospice and palliative care! (n %orth ?merica, hospice has evolved into a t pe of time&limited end&of&life care that is not specificall focused around palliative services![5] %on&hospice palliative care, however, is appropriate for an one with a serious, comple$ illness, whether the are e$pected to recover full , to live with chronic illness for an e$tended time, or to e$perience disease progression![6]

[edit] Goals
=hile palliative care ma seem to offer an incredi)l )road range of services, the goals of palliative treatment are e$tremel concrete: relief from suffering, treatment of pain and other distressing s mptoms, ps chological and spiritual care, a support s stem to help the individual live as activel as possi)le, and a support s stem to sustain and reha)ilitate the individualAs famil ![8]

[edit] History
.alliative care toda is no longer limited to hospice care, however palliative care )egan in the hospice movement! Hospices were originall places of rest for travelers in the 4th centur ! (n the /;th centur a religious order esta)lished hospices for the d ing in (reland and London! "he modern hospice is a relativel recent concept that originated and gained momentum in the *nited +ingdom after the founding of St! 0hristopherAs Hospice in /;68! (t was founded ) 7ame 0icel Saunders, widel regarded as the founder of the modern hospice movement! Decentl , the hospice movement has grown dramaticall ! (n the *+ in 1CC5 there were 'ust under /8CC hospice services, consisting of 11C inpatient units for adults with 2/56 )eds, 22 inpatient units for children with 155 )eds, 259 home care services, /C4 hospice

at home services, 162 da care services and 1;2 hospital teams! "hese services together helped over 15C,CCC patients in 1CC2E4! :unding varies from /CCB funding ) the %ational Health Service to almost /CCB funding ) charities, )ut the service is alwa s free to patients! Hospice in the *nited States has grown from a volunteer&led movement to improve care for people d ing alone, isolated, or in hospitals, to a significant part of the health care s stem! (n 1CC5 more than /!1 million individuals and their families received hospice care! Hospice is the onl Fedicare )enefit that includes pharmaceuticals, medical e#uipment, twent &four hourEseven da a week access to care and support for loved ones following a death! "he ma'orit of hospice care is delivered at home or in a home&like hospice residence! Hospice care is also availa)le to people in nursing homes, assisted living facilities, veteransA facilities, hospitals and prisons! "he first *nited States hospital&)ased palliative care programs )egan in the late /;9Cs at onl a handful of institutions such as the 0leveland 0linic and Fedical 0ollege of =isconsin! Since then there has )een a dramatic increase in hospital&)ased palliative care programs, now num)ering more than /1CC! >ver 55B of *!S! hospitals over /CC )eds have a program![9] Hospital palliative care programs toda care for non&terminal patients as well as hospice patients! .alliative care programs in hospitals can )e difficult to financiall support given the multiple emplo ees on a palliative care team and the time& intensive involvement with patients without ade#uate reim)ursement! "herefore, strategies for funding palliative care programs t picall focus on cost&savings for the hospital as opposed to revenue&generating models!

[edit] Practice
(n the *nited States, hospice and palliative care represent two different aspects of care with similar philosoph , )ut different pa ment s stems and location of services! .alliative care services are most often provided in acute care hospitals organi@ed around an interdisciplinar consultation service with or without an acute inpatient palliative care ward! .alliative care ma also )e provided in the d ing personAs home as a -)ridgeprogram )etween traditional *S home care services and hospice care or provided in long&term care facilities! (n contrast, over 9CB of hospice care in the *S is provided in a patientAs home, with the remainder provided to patients residing in long&term care facilities or in free standing hospice residential facilities! (n the *+, hospice is seen as one part of the specialt of palliative care and no differentiation is made )etween AhospiceA and Apalliative careA! (n most countries, hospice and palliative care is provided ) an interdisciplinar team consisting of ph sicians, registered nurses, social workers, hospice chaplains, ph siotherapists, occupational therapists, complimentar therapists, volunteers and, most importantl , the famil ! "he focus of the team is to optimi@e the patientAs comfort! ?dditional mem)ers of the team are likel to include certified nursing assistants or home health care aides, volunteers from the communit (largel untrained )ut some )eing skilled medical personnel as well), and housekeepers! (n the *+ palliative care services offer inpatient care, home care, da care, outpatients

and work in close partnership with mainstream services! Hospices often house a full range of services and professionals for )oth pediatric and adult patients! (n the *S, palliative care services can )e offered to an patient with no restrictions on disease t pe or e$pected prognosis! However, hospice care under the Fedicare Hospice Genefit, re#uires that two ph sicians certif that a patient has less than si$ months to live, if the disease follows its usual course! "his does not mean, however, that if a patient is still living after si$ months in hospice, he or she will )e discharged from the service! Such restrictions do not e$ist in other countries such as the *+! 0aregivers, )oth famil and volunteers, are crucial to the palliative care s stem! Gecause of the amount of individual contact, caregivers and patients often form lasting friendships et conse#uentl , caregivers ma find themselves under severe emotional and ph sical strain! >pportunities for caregiver respite are some of the services hospices provide to promote caregiver well )eing! Despite ma )e for several hours or up to several da s (the latter )eing done usuall ) placing the patient in a nursing home or in&patient hospice unit for several da s)! Gecause palliative care sees an increasingl wide range of conditions in patients at var ing stages of their illness, it follows that palliative care teams offer a wide range of care! "his ma range from managing the ph sical s mptoms in patients receiving active treatment for cancer, through treating depression in patients with advanced disease, to the care of patients in their last da s and hours! Fuch of the work involves helping patients with comple$ or severe ph sical, ps chological, social and spiritual pro)lems! (n the *+ over half of patients are improved sufficientl to return home! (f a patient dies, it is common for most hospice organi@ations to offer )ereavement counseling to the patientAs partner or famil ! (n the *S, )oard certification for ph sicians in palliative care is through the ?merican Goard of Hospice and .alliative Fedicine, more than 5C fellowship programs provide /&1 ears of specialt training following a primar residenc ! (n the *+, palliative care has )een a full specialt of medicine since /;9; and training is governed ) the same regulations through the Do al 0ollege of .h sicians as with an other medical specialt ! :unding for hospice and palliative care services varies! (n the *+ and man other countries, all palliative care is offered free to the patient and their famil , either through the %ational Health Service (as in the *+) or through charities working in partnership with the local health services! .alliative care services in the *S are paid ) philanthrop , fee&for service mechanisms or from direct hospital support, while hospice care is provided as Fedicare )enefit, similar hospice )enefits are offered ) Fedicaid and most private health insurers! *nder the Fedicare Hospice Genefit (FHG), a patient signs off their Fedicare .art ? (hospital pa ment) and enrolls in the FHG with direct care provided ) a Fedicare certified hospice agenc ! *nder terms of the FHG, the Hospice agenc is responsi)le for the .lan of 0are and ma not )ill the patient for services! "he hospice agenc , together with the patientAs primar ph sician, is responsi)le for determining the .lan of 0are! ?ll costs related to the terminal illness are paid from a per diem rate (H*S I/16Eda ) that the hospice agenc receives from Fedicare&this includes all drugs and e#uipment, nursing, social service, chaplain visits and other services deemed appropriate ) the hospice agenc , Fedicare does not pa for custodial care! .atients ma elect to sign&off the FHG and return to Fedicare .art ? and re&enroll in

hospice at a later time!

[edit] Dealing with distress

"he ke to effective palliative care is to provide a safe wa for the individual to address their ph sical and ps chological distress, that is to sa their total suffering, a concept first thought up ) 7ame 0icel Saunders, and now widel used, for instance ) authors like "w cross or =oodruff![;] 7ealing with total suffering involves a )road range of concerns, starting with treating ph sical s mptoms such as pain, nausea and )reathlessness! "he palliative care teams have )ecome ver skillful in prescri)ing drugs for ph sical s mptoms, and have )een instrumental in showing how drugs such as morphine can )e used safel while maintaining a patientAs full faculties and function! However, when a patient e$hi)its a ph siological s mptom, there are often ps chological, social, or spiritual s mptoms as well! "he interdisciplinar team, which often includes a social worker or a counselor and a chaplain, can pla a role in helping the patient and famil cope glo)all with these s mptoms, rather than depending on the medicalEpharmacological interventions alone! *suall , a palliative care patientAs concerns are pain, fears a)out the future, loss of independence, worries a)out their famil , and feeling like a )urden! =hile some patients will want to discuss ps chological or spiritual concerns and some will not, it is fundamentall important to assess each individual and their partners and families need for this t pe of support! 7en ing an individual and their support s stem an opportunit to e$plore ps chological or spiritual concerns is 'ust as harmful as forcing them to deal with issues the either donAt have or choose not to deal with! Some charities for the hospice movement offer free, self learning online programmes covering all aspects of palliative care, including management of distress![/C] ?lternative medical treatments such as rela$ation therap ,[//][/1] massage,[/2] music therap ,[/4] and acupuncture[/5] can relieve some cancer&related s mptoms and other causes of suffering! "reatment that integrates complementar therapies with conventional cancer care is integrative oncolog !