If your patient was recently diagnosed with a life-threatening or chronic illness, chances are you’ve been working with specialists of the illness to help treat or control it to prolong the patient’s life. In the last ten years, a new specialty was birthed as a result of such collaboration: palliative medicine.
Palliative medicine refers to the specialization of caring for those with life-threatening and other serious diseases. Its purpose is to relieve its patients of the most troubling symptoms, stress and other pains that come with the disease, regardless of the diagnosis.
What is the Purpose of Palliative Medicine?
The primary goal of palliative care is to relieve patients of difficult symptoms in order to improve overall quality of life. A patient’s team is comprised of several doctors, nurses and additional specialists, all of whom work together to come up with a personalized layer of support to complement his or her existing care. It’s an appropriate supplemental service for patients of any age or suffering from any stage of a chronic illness.
Guidelines to Palliative Care
A multifaceted palliative care team can focus on everything from weight loss to providing resources within the community to issues related to faith as well as managing pain related to the illness. The team will work with someone struggling with side effects of their treatment as well as patients who were recently diagnosed. Depending on the palliative team, some members may have hospice board certification or may be certified specifically in palliative care; others may specifically serve another role, such as acupuncturist or a chaplain of the patient’s faith.
A palliative consult can help your patient quickly receive important information that will help the patient and the family understand the benefits palliative care can offer in conjunction with core treatment. It will provide a safe place for the patient while allowing you to provide the best appropriate care.
Palliative Care Essential Information
Even if you do not personally suggest palliative care to chronically ill patients, you must prepare for patients who will ask about it on their own. Here are a few frequently asked questions to keep in mind when approached with the subject:
Where will I find a palliative care team?
Most hospitals hire at least one palliative specialist. These physicians are board certified in hospice and palliative medicine. Hospice providers also utilize palliative care specialists.
What kind of people are on a palliative care team?
Most teams are made up of a doctor, a nurse and a social worker. Depending on the needs of the patient, teams can also include a pharmacist, a physical therapist, a rehabilitation specialist, a chaplain of the patient’s faith, a counselor, art and music therapists, health aides for home, and many others.
How do hospice care and palliative care differ?
Both are holistic practices that seek to improve quality of life for affected patients. Hospice takes it a step further, caring for patients who are no longer able to undergo curative care and expect to life six months or less.
Who will pay for palliative care?
In many cases, insurance companies will include palliative benefits for the policyholder. Medicare does not provide coverage except for patients expecting to live six months or less and who have also decided not to take curative treatment. Currently, there are no reimbursements or regulations available for Medicare. Other insurance policies will vary.
What roles do palliative team members fulfill?
Besides making the patient more comfortable, a palliative care team will help patients and doctors communicate with one another so the patient and the family will all better understand the disease. The team also lays the bridge for a smoother transition from the hospital to home care or a new facility. The care team educates patients and his or her family about expectations to maintain throughout the course of treatment.
Palliative Care Criteria for Patients
The patient, team and/or family may need help with determining long-term goals for care and similar decisions for situations such as:
Prognosis is uncertain
- Uncertainty of which therapy option is appropriate
- Uncertain whether patient is at end-of-life and whether hospice care is needed
There are conflicts over care decisions:
- The patient or the family believes the team is ineffectual
- Conflicts with Do-Not-Resuscitate order
- Conflicts with artificial hydration and nutrition in dying patient
- Distress impeding decision making
Information indicating further deterioration:
- Recently diagnosed with life-threatening illness
- Function declining and making daily living difficult or impossible
- Unexplained, persistent weight loss
- Admission to the hospital from a long term care facility
Patient suffers unacceptable, persistent symptoms for over 24 hours:
- Delirium
- Dyspnea
- Pain
- Spiritual / emotional suffering
- Nausea
Admissions to the emergency room or hospital:
- Patient went to emergency room for the same diagnosis more than once within one month
- Patient was admitted to the hospital more than twice in three months for the same diagnosis
- Patient stayed at the hospital more than five days with no signs of improvement
- Patient had a prolonged ICU stay or more than two ICU transfers from the same admission with no signs of improvement
- Patient is actively in ICU with multiple organ failure
Ventilators:
- Failure to wean from ventilator
- Considering rapid weaning
- Considering transfer to long-term ventilation
Additional qualifying clinical criteria:
- Brain metastases
- Anoxic encephalopathy
- Metastatic cancer with multiple treatment failures
- Neurologic complications due to cancer
- Neurodegenerative disease with ventilator or feeding support
- Advanced renal disease with dialysis but still deteriorating
- Advanced cardiac disease requiring LVAD or IV pressors
- Advanced lung disease with excessive exacerbations
- Spinal cord compression
- Stroke with life-limiting function decrease
- Carcinomatous meningitis
- Severe/catatrophic multiple traumas
