When is Palliative Care Appropriate?
Some people hear the word PALLIATIVE, and immediately sense images of hospice and death. Sometimes families hesitate to seek resources or enroll in services because the larger infrastructure and ‘rules’ make patients and families feel too much of the ‘reality’ of inevitable.
It is important to understand that the sub-specialty of Palliative Care Medicine is provided by specialized medical professionals who collaborate with a patient’s other doctors to provide an extra layer of support while patient receive other mitigating and curative treatments. It is appropriate at ANY AGE and at ANY STAGE in a serious, complex or progressive illnesses such as cancer, cardiac and pulmonary diseases, liver and kidney diseases, autoimmune and connective tissue diseases, and neurodegenerative disorders such as Parkinson disease, Huntington disease, Alzheimer and other dementias, and Amyotrophic Lateral Sclerosis.
Palliative Care Treats the Person. Not the Disease.
It is a more refined and specialized primary care service that should be offered when significant illness or injury has resulted in permanent life changes that may affect quality or quantity of life:
When curative therapies are no longer effective and the patient's and family's goals of care are changing
When difficult symptoms compromise one’s ability to continue treatment
When patients, families or significant others experience emotional distress, hopelessness or demoralization
When documentation on or simply a discussion about wishes and treatment preferences is needed
When patient’s advance directives do not support their current treatment plan
When a patient has been readmitted for more than twice in six months for treatment of a chronic or advanced illness
Sometimes it is simply symptom management for fatigue, anxiety, insomnia, depression, constipation, anorexia and/or pain.
Palliative Care Improves Quality of Life
Because Palliative Care also involves goals of care and patient and family emotional support, it also improves health and quality of life by supporting the primary care provider, the patient and the family. Palliative Care uniquely offers:
Time to devote to intensive family meetings and patient/family communication.
Communication and support for resolving family/patient/physician questions concerning goals of care.
Expertise in managing complex physical and emotional symptoms
Coordination of care transitions across health care settings.
Palliative Care Physicians also help improve:
Patient and family satisfaction with their overall medical treatment and supporting care team members.
Patient and family goals to maintain control of their environment, avoiding unnecessary hospitalization and exposures.
Patient and family understanding of the nature of their illnesses so that they may be able to make timely, informed decisions about their care.
Palliative Care Means to Enable and Empower
For those who are still having difficulty coming to terms with an advancing illness, it is sometimes easier to work with just a Physician and then build his or her own TEAM. This way a more intimate therapeutic relationship can develop, which may facilitate improved symptom and medication management, as well as assist with education and communication surrounding this difficult time.
The North Shore Osteopathic TEAM consists of only who the patient and family are ready to have participate, and for however long they feel they need this support into the foreseeable future - whether it is days, weeks, months or years thereafter. The North Shore Osteopathic TEAM will reach out to other professionals - with the patient and family’s consent - for psychological, spiritual and financial support.
Having the patient and family chose their own TEAM members may be the best way to assist in educating family members how to navigate through troubled waters, as well as teach them how to best care for the patient using their own resources - ultimately saving money and gaining autonomy in making these important decisions, rather than just taking whomever is assigned at that time.
North Shore Osteopathic is willing to assist with:
Finding home health support services and transportation, as needed
Exploring patient goals and wishes
Clarifying diagnosis, prognosis and treatment options
Reviewing and encouraging preventative medicine opportunities
Supporting the completion of an advanced directive / POLST form
Promoting ongoing communication between the physician, patient, family, and multi-disciplinary team
Advocating for the patient when she or he is having difficulty communicating wishing about treatment options or even cessation
Providing information and support for families faced with difficult decisions about appropriate care and support outside the hospital or office settings
Questions to Ask the Patient
Who should make healthcare decisions on your behalf if you are unable?
What are your greatest concerns or fears?
What do you consider as having good quality of life?
If prolonged life does not give you quality of life, do you still want aggressive medical interventions if prognosis is grim or futile?
If you could decide, what would you want done in such circumstances?
How do you want to live out your last 6 months of life?
Do you wish to become an organ donor?
Questions to Ask the Healthcare Team
What is my working diagnosis?
What is my prognosis . . . meaning, is my diagnosis life-limiting?
What are my treatment options?
What is the most likely outcome for each treatment option?
What are the burdens and benefits of each option?
How much time or improvement in symptoms will I gain by undertaking aggressive treatments versus more conservative treatments?
Am I eligible for Hospice? ( Medicare payment for medications, clinical and sub-clinical visits, social work and chaplain support, hospital bed and equipment for mobility, toileting and hygiene for patients who are not anticipated to live more than six months)