What is the difference between palliative care and hospice care in terms of patient eligibility and treatment goals?

Palliative Care vs. Hospice Care: Eligibility and Treatment Goals

Palliative care should be initiated at diagnosis and provided concurrently with disease-directed therapies, while hospice care is specifically for patients with a terminal prognosis of less than 6 months who are no longer pursuing curative treatments. 1

Key Differences Between Palliative Care and Hospice Care

Palliative Care

• Eligibility: Available to patients at any point in a serious illness, regardless of prognosis
• Timing: Should begin at diagnosis and continue throughout disease trajectory
• Treatment Goals:
  • Focuses on symptom management and quality of life
  • Delivered concurrently with disease-directed, life-prolonging therapies
  • Facilitates patient autonomy, access to information, and choice
• Delivery Model:
  • Initiated by primary oncology/medical team
  • Augmented by collaboration with palliative care specialists
  • Can be provided in any setting (hospital, outpatient, home)

Hospice Care

• Eligibility:
  • Terminal prognosis with life expectancy of less than 6 months
  • Requires certification by treating physician and hospice medical director 1, 2
  • Patient must agree in writing to forego curative treatments for terminal illness 1
• Timing: Focused on the last phase of an incurable disease
• Treatment Goals:
  • Maximizing comfort and quality of remaining life
  • No longer pursuing disease-directed, life-prolonging therapies
• Delivery Model:
  • Provided by interdisciplinary team
  • Can be delivered in multiple settings (home, facility, inpatient)
  • Medicare benefit with specific requirements

Screening Criteria for Palliative Care Referral

Patients should be screened at every visit for: 1

1. Uncontrolled symptoms
2. Moderate to severe distress related to diagnosis and therapy
3. Serious comorbid physical, psychiatric, and psychosocial conditions
4. Life expectancy of 6 months or less
5. Patient/family concerns about disease course and decision-making
6. Specific request for palliative care

Important Considerations

Palliative Care Misconceptions

• Palliative care is often incorrectly used as a synonym for end-of-life or hospice care 3
• Unlike hospice, palliative care does not require a terminal diagnosis or proximity to death
• Palliative care can be provided alongside curative treatments

Hospice Care Clarifications

• Patients do NOT need a "do not attempt resuscitation" order to enroll in hospice 1, 2
• If patients survive beyond 6 months, Medicare will continue coverage if they still meet eligibility criteria 1, 2
• Patients can be withdrawn from hospice if their condition unexpectedly improves 1

Benefits of Early Palliative Care Integration

• Improved quality of life and mood
• Reduced symptom burden
• Potential for improved survival
• Better caregiver outcomes
• Enhanced patient understanding of prognosis and goals of care 3, 4

Common Pitfalls to Avoid

1. Delayed referral: Waiting until end-of-life to initiate palliative care services limits their benefits
2. Equating palliative care with giving up: Palliative care should be reframed as "fighting" for better quality of life, not "giving up" 1
3. Underutilization in certain populations: Patients with non-cancer diagnoses (like COPD) often receive less palliative care than cancer patients 1
4. Confusion about eligibility: Many providers and patients misunderstand the difference between palliative and hospice care
5. Communication barriers: Lack of advance care planning and depression can impede effective communication about palliative care options 1

By understanding these distinctions, healthcare providers can ensure patients receive appropriate care aligned with their disease stage, prognosis, and treatment goals, ultimately improving quality of life and potentially survival outcomes.