This is the most common question I am asked during a hospice and palliative care consult! The difference between these two treatment approaches can be confusing for most people as well as for my medical colleagues, so I am writing this blog on the topic in an attempt to help clarify the matter.
To “palliate” means to make symptoms better. Palliative care is a treatment approach focused on alleviating symptoms. When a palliative care consult is requested, it is usually because a patient has a serious illness for which they are receiving aggressive treatment and are having a lot of symptoms that are interfering with their usual daily activities. A common example would be a patient with cancer receiving chemotherapy to cure or at least slow the progression of their disease. These treatments frequently result in unpleasant side effects such as nausea, fatigue, insomnia, and anxiety. If these symptoms become severe and begin to interfere with the patient’s ability to enjoy life as they normally would, palliative care can help with therapies to alleviate these so they can continue treatment and live their normal daily lives. Other common diseases treated by palliative care include end-stage heart disease, kidney disease, liver disease, lung disease, stroke, dementia, AIDS, and Parkinson’s disease.
Hospice on the other hand is a benefit provided by Medicare and most private insurances to pay for care when a patient with serious illness is no longer receiving curative treatments for their disease and is expected to have only 6 months left to live. It is a team of providers including a physician, RN, LPN, social worker and spiritual care provider as well as volunteers if requested who help with the care needs of the patient in their home. Hospice was previously “a place patients went to die” to avoid dying in the hospital, but nowadays most hospice care occurs in a patient’s home, usually a private house, nursing home, or assisted living facility. A primary goal of the hospice team is to provide the care needed so the patient can remain in their home for as long as possible. Another important goal is to provide treatment of symptom flares at home to avoid trips to the emergency room or hospital which can be very stressful for both the patient and their family. Hospital care becomes less effective and can even add to the patient’s suffering as their disease progresses. At that stage of illness, symptom management is the only effective treatment, and this can be provided at home by the patient’s caregivers with the help of their hospice team.
Another point of confusion between these different treatment approaches is that although hospice care always includes symptom management, i.e. palliative care, palliative care does not always include hospice. There have been incredible advances in treating severe and even terminal illnesses in recent years which allow many patients to live for several months and even years with their disease. Hospice is only needed or even an option when the patient’s condition deteriorates to the point that their doctor believes they may be within the last 6 months of their life. Until that point, palliative care can help to manage symptoms and maintain the patient’s usual lifestyle while they continue to fight their disease.
This overlap of hospice and palliative care has resulted in an understandable confusion between these care approaches. Both patients and clinical professionals are often unclear about these differences and when each is appropriate and indicated. This confusion coupled with the common reluctance to acknowledge the end stages of a terminal illness by both patients and providers, unfortunately, can result in patients not receiving palliative care or hospice services when they could most benefit from them, or for as long as they would be eligible to receive them.
The goals of both palliative care and hospice care are living life to the fullest and maximizing quality of life while facing the challenges of a life-limiting or terminal illness. Those with illness and those helping to care for them require and are entitled to services to help them achieve these goals. These services are now an established, well-accepted option for all patients with these illnesses. They are also covered by all health insurance plans, making them available and accessible to all patients who need them.
Recognizing the blessing and benefits of these services, the second most common question I receive during Palliative Care & Hospice consults is “Why didn’t someone tell me about this sooner?!” I encourage all who are struggling to cope with a life-limiting or terminal disease or those who care for them to request a palliative care consultation to find out what services are available to you to help you along this journey. No one has to feel alone at such a critical and vulnerable time, especially when so many resources are available to you.
Author: Leslie Massoglia, MD, Former Addiction Specialist with MyCatholicDoctor
Editor: Samantha Wright, Director of Education and Online Resources with MyCatholicDoctorLeave a reply