What Is Palliative Care?
Palliative Care for the Patient with Progressive, Incurable Disease
Integrating Palliative Care into Current Treatment Models
Palliative Care as a Medical Specialty
Care Resources (.pdf)
Palliative Care Websites
Glossary of Palliative Care Terms
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
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.
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.
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.
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.
American Academy of Hospice and
American Board of Hospice and
End-of-Life Physician Education
European Association for Palliative
Growth House, Inc.
and Palliative Care Formulary USA, 2nd Edition (.pdf)
International Association for Hospice & Palliative Care
Hospice and Palliative Care Organization
Pallipedia: Online Palliative Care Dictionary
The Grieving Center
U.S. Dept. of
Health and Human Services: A Clinical Guide on Supportive and Palliative Care
for People with HIV/AIDS, 2003
WHO Palliative Care: Cancer Control Knowledge Into Action, WHO Guide for Effective Programmes (.pdf)
WHO Palliative Care: Symptom Management and End-of-Life Care Booklet (.pdf)
- DPMPC palliative care videos
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