What is the difference between palliative care and hospice care for a patient with a serious illness?

Palliative Care vs. Hospice Care

Palliative care is broader care that can be provided at any stage of serious illness alongside curative treatment, while hospice care is a subset of palliative care specifically for patients with terminal illness and life expectancy of 6 months or less who are no longer pursuing curative treatments. 1, 2

Key Differences Between Palliative Care and Hospice Care

Timing and Eligibility

• Palliative care can begin at any stage of illness, including at diagnosis, and can be provided concurrently with curative or life-prolonging treatments 1
• Hospice care is specifically for patients with a prognosis of 6 months or less if the disease follows its expected course, and typically involves discontinuing curative treatments 1, 3

Treatment Goals

• Palliative care aims to improve quality of life through symptom management while patients may still be receiving disease-modifying treatments 1, 4
• Hospice care focuses on comfort and quality of life when curative treatments are no longer beneficial or desired, with emphasis on comprehensive end-of-life support 1, 3

Service Delivery Models

• Palliative care follows an individualized integrated model where patients receive palliative care concurrently with curative/restorative care, with intensity adjusted based on patient and family needs 1
• Hospice care provides a comprehensive package of services including medical care, pain management, and emotional/spiritual support specifically tailored for end-of-life needs 3

Care Settings

• Palliative care can be delivered in various settings: hospitals, outpatient clinics, long-term care facilities, or at home 4, 5
• Hospice care is most commonly provided in the patient's home (or residence), but can also be delivered in dedicated hospice facilities, long-term care facilities, or hospitals when needed for symptom control 1, 3

Core Components of Both Services

Symptom Management

• Both approaches emphasize management of physical symptoms including:
  • Pain control using NSAIDs, opioids, and bisphosphonates for cancer-related pain 1, 2
  • Dyspnea management with opioids for unrelieved symptoms and oxygen for hypoxemia 1, 2
  • Depression treatment with antidepressants and psychosocial interventions 1, 2

Interdisciplinary Team Approach

• Both utilize teams that may include physicians, nurses, social workers, chaplains, and trained volunteers 1, 3
• Hospice teams specifically include a hospice medical director, nurses, social workers, counselors, home health aides, and volunteers 3

Family Support

• Both provide support for families, but hospice extends bereavement services for families up to one year after the patient's death 1, 6
• Both approaches screen caregivers for practical and emotional needs 1, 2

Common Pitfalls to Avoid

• Delaying palliative care consultation until end-of-life - evidence shows early palliative care can improve both quality and duration of life 1
• Undertreatment of symptoms, particularly dyspnea, due to unfounded concerns about respiratory depression from opioids 2
• Confusing palliative care with hospice care, which limits access to palliative services for patients who could benefit earlier in their illness trajectory 7, 5
• Failing to complete advance care planning early in the course of serious illness 1, 2

Decision Algorithm for Appropriate Referral

1. For patients with serious illness at any stage who have uncontrolled symptoms (pain, dyspnea, depression):

   • Refer to palliative care services while continuing disease-directed treatment 1, 4

2. For patients with advanced illness with life expectancy ≤6 months who are no longer pursuing curative treatment:

   • Refer to hospice services for comprehensive end-of-life care 1, 3

3. For patients transitioning between curative and comfort-focused care:

   • Consider concurrent palliative care to help with the transition and decision-making process 1, 5