What is Palliative Care?
Palliative care is a comprehensive approach focused on relieving suffering and improving quality of life for patients with serious, life-limiting illnesses through expert management of physical symptoms, psychological distress, and spiritual needs—delivered alongside curative treatments from the time of diagnosis, not reserved for end-of-life. 1, 2
Core Definition and Philosophy
Palliative care addresses the physical, psychological, social, and spiritual suffering of patients facing life-threatening illness and extends support to their families and caregivers. 1 The World Health Organization defines it as care that:
- Provides relief from pain and other distressing symptoms 1
- Affirms life and regards dying as a normal process 1
- Intends neither to hasten nor postpone death 1
- Integrates psychological and spiritual aspects of patient care 1
- Offers support systems to help patients live as actively as possible until death 1
- Uses a team approach including bereavement counseling for families 1
Critical Distinction: When Palliative Care Begins
Palliative care should start when a patient becomes symptomatic with serious illness, not when death is imminent, and continues concurrently with all curative and life-prolonging treatments. 1, 3 This represents a fundamental shift from prognosis-based to needs-based care. 2
For example, a patient with metastatic cancer can receive chemotherapy, radiation, and aggressive disease-directed treatments while simultaneously receiving palliative care for pain management, psychological support, and advance care planning. 3, 4 The intensity of palliative interventions is adjusted based on symptom burden and patient preferences throughout the disease trajectory. 1
Who Provides Palliative Care
There are three levels of palliative care delivery:
- Palliative care approach: Basic symptom management and psychosocial support provided by all clinicians caring for seriously ill patients (primary palliative care) 1, 5
- Generalist palliative care: Provided by clinicians with additional training but not specialty certification 6
- Specialist palliative care: Delivered by interdisciplinary teams including physicians, nurses, social workers, chaplains, and other specialists for complex cases 1
What Palliative Care Addresses
The interdisciplinary team manages:
- Physical symptoms: Pain, dyspnea, nausea, fatigue, respiratory secretions, agitation 1, 7
- Psychological needs: Depression, anxiety, existential distress, fear 1
- Social concerns: Family dynamics, caregiver burden, financial strain, discharge planning 1
- Spiritual issues: Meaning-making, religious concerns, legacy work 1
- Communication and decision-making: Goals of care discussions, advance care planning, conflict resolution 1, 7
Common Misconception: Palliative Care vs. Hospice
A critical pitfall is confusing palliative care with hospice—they are not the same. 3, 8
Palliative care:
- Based on need and symptom burden, not prognosis 2, 9
- Delivered alongside curative treatments 3, 4
- No requirement to forgo disease-directed therapy 3
- Available across all care settings from diagnosis forward 1, 2
Hospice care:
- Requires physician certification of terminal prognosis (≤6 months) 1, 3
- Requires patients to forgo curative treatments for their terminal illness 1, 3
- Focuses exclusively on comfort measures 3
- Operates under specific Medicare/Medicaid benefit structure 1, 3
Eligibility Criteria
Any patient with serious chronic or life-limiting illness should receive palliative care based on symptom burden, not prognosis alone. 2 Specific triggers include:
- Uncontrolled physical symptoms at any disease stage 2
- Moderate to severe psychological distress 2
- Progressive chronic diseases (COPD, heart failure, cirrhosis, chronic kidney disease) when symptomatic 2
- All metastatic cancer patients, particularly lung, pancreatic, and glioblastoma 2
- Performance status decline or metabolic/neurologic complications 2
- Patient or family request for palliative services 2
Settings Where Palliative Care is Delivered
Palliative care operates across the continuum:
- Hospital-based: Consultation teams, dedicated palliative care units 4, 9
- Intensive care units: From time of ICU admission for all critically ill patients 5, 9
- Outpatient clinics: Concurrent with oncology, cardiology, pulmonology visits 4, 8
- Emergency departments: For acute symptom crises 1
- Rehabilitation facilities: During recovery from acute illness 1
- Home-based: Through palliative home care programs 1, 8
Goals of Care Framework
When prognosis is uncertain or poor, the palliative care team facilitates structured discussions addressing:
- Patient's current health status and realistic expectations 1, 7
- Relative importance of quality of life versus length of life 7
- Medical appropriateness of specific interventions (feeding tubes, hydration, ICU admission, mechanical ventilation, CPR) 7
- Preferred location of care if condition worsens 1
- Advance directives and surrogate decision-makers 1, 7
These discussions should be revisited periodically as the patient's condition changes. 1
Avoiding Critical Errors
Do not delay palliative care consultation until end-of-life—this negatively impacts both quality and duration of life. 7, 2 Early palliative care integration has been shown to improve outcomes, reduce hospital readmissions, and lower costs while maintaining or extending survival. 7
Do not restrict palliative care to cancer patients. Patients with COPD, heart failure, and other chronic progressive diseases receive significantly less palliative care due to communication barriers and lack of advance care planning, which must be addressed proactively. 1, 3
Prognostic uncertainty should never delay referral. Palliative care is appropriate whenever symptom burden exists, regardless of whether death is expected in months or years. 2, 9