What Is Palliative Care?

Palliative care is an interdisciplinary model of care focused on patients with serious or life-threatening illness and their families. The goal of palliative care is to reduce illness burden, relieve suffering, and maintain quality of life from the time of diagnosis onward. This goal is accomplished through interventions that maintain physical, psychological, social and spiritual well-being; improve communication and coordination of care; ensure culturally-appropriate care that is consistent with the values and preferences of the patient; provide for concrete assistance if needed; and increase the likelihood that the period surrounding the time of active dying occurs with minimal suffering and opportunities for closure.

Palliative care interventions can be "generalist", provided by any clinician caring for a patient with a serious or life-threatening illness, or "specialist", provided by a team of specialists either through a consultation program or a hospice program.

As the model is applied throughout the course of the illness, it includes an array of interventions that are intended to maintain the quality of life, or attenuate the suffering, of the patient and family. As death approaches, palliative care must intensify and ensure that comfort is a priority, practical needs are addressed, psychosocial and spiritual distress is managed, values and decisions are respected, and opportunities are available for growth and resolution.

Palliative care is both an approach to patient care that should be routinely integrated with life-prolonging therapies and a growing practice specialty for highly trained physicians, nurses, social workers, chaplains, and others. Palliative medicine is the medical specialty dedicated to excellence in palliative care. Palliative care specialists typically work in teams and usually are needed when the disease is advanced, life expectancy is short, and problems become complex and more urgent. In practice, these problems most often relate to uncontrolled symptoms, conflicted or unclear goals of care, distress related to the process of dying, and increasing family burden.

The definition of palliative care has much in common with hospice. In the United States, however, palliative care is evolving in a way that goes well beyond the American version of hospice. Palliative care aims to address the physical, psychosocial, and spiritual concerns that contribute to both the quality of life and quality of dying for patients with life-threatening illnesses at any phase of the disease. Although the focus intensifies at the end of life, the core issues -- comfort and function -- defined broadly and evaluated within the context of the family, are important throughout the course of the disease.

Palliative Care for the Patient with Progressive, Incurable Disease

For the many patients with incurable and progressive diseases who are undergoing active life-prolonging therapies and have life expectancies that potentially extend to years, palliative care includes symptom management, therapy aimed at restoring function, practical support, and psychological interventions. At all stages of the disease, effective palliative care increases the likelihood that the patient will cope adequately with the rigors of therapy and maintain a satisfying level of physical and psychosocial functioning.

For the dying patient, optimal palliative care addresses the traditional concerns of the hospice movement. Comfort for the patient and preparation of both the patient and family for the inevitability of dying are often the overriding challenges in this setting. This preparation may have to address a broad range of psychological, social, family, and spiritual concerns.

Integrating Palliative Care into Current Treatment Models

All patients with progressive, incurable diseases, and the families of these patients, need ongoing palliative care throughout the course of the disease, from the time of diagnosis until whatever the final outcome. During much of this period, palliative care will focus on the provision of medical and nonmedical interventions intended to help the patient and family maintain the best quality of life possible as the patient lives with the disease. As the disease becomes more advanced, palliative care begins to focus on maintaining patient comfort, ensuring that other needs are addressed, and a variety of other tasks that may be important at the end of life can be accomplished. Family support at this time, including bereavement support, is essential.

Palliative Care as a Medical Specialty

Most palliative care should be organized by the patient's primary physician. The evolving perspective of palliative care also has encouraged the gradual acceptance of a medical specialization in this area. Palliative medicine is a recognized subspecialty of medicine in several countries and has gained the stature of academic posts in the United Kingdom, Canada, Australia, and elsewhere. Palliative care specialists are needed in the setting of advanced disease, when the needs of the patient and family intensify, and they also provide leadership in the areas of education and research. Like other areas of medicine, progress in palliative care requires both support of better practice on the part of clinicians and support for the development of a genuine specialty.

Palliative Care Websites

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