What is Palliative Care
Palliative care is patient- and family-centered medical care that focuses on relieving suffering through effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual support according to patient needs, values, beliefs, and cultures, with the goal of optimizing quality of life regardless of disease stage or prognosis. 1
Core Definition and Philosophy
Palliative care represents both a philosophy of care and an organized system for delivering care to persons with life-threatening or debilitating illness. 1 The fundamental goals are to anticipate, prevent, and reduce suffering while supporting the best possible quality of life for patients and their families. 1
Key Distinguishing Features
Palliative care begins at diagnosis and should be delivered concurrently with disease-directed, life-prolonging therapies—it is not synonymous with end-of-life care or hospice. 1, 2 This represents a critical paradigm shift: palliative care can and should coexist with curative treatments. 2, 3 It only becomes the main focus of care when disease-directed therapies are no longer effective, appropriate, or desired. 1
Essential Components of Palliative Care
Symptom Management
The American College of Physicians mandates regular assessment and treatment of:
- Pain: Using NSAIDs, opioids, and bisphosphonates (particularly effective for bone pain in breast cancer and myeloma) 1, 2
- Dyspnea: Using opioids for severe unrelieved dyspnea and oxygen for hypoxemia 1, 2
- Depression: Using tricyclic antidepressants, SSRIs, or psychosocial interventions 1, 2
Psychosocial and Spiritual Care
Palliative care addresses psychological well-being, care coordination, advance care planning, and caregiver burden as core elements. 1 This includes screening adult caregivers routinely for practical and emotional needs, providing support through listening to concerns, attention to grief, and regular information updates. 2, 4
Advance Care Planning
All patients with serious illness must have advance care planning, including completion of advance directives, addressing surrogate decision makers, resuscitation preferences, and emergency treatment preferences. 1, 2 This should occur as early as possible in the course of serious illness, not delayed until the terminal phase. 1, 2
Delivery Model
Palliative care should be provided by an interdisciplinary team of medical and mental health professionals, social workers, and spiritual counselors. 1 The National Comprehensive Cancer Network specifies that palliative care should be initiated by the primary oncology team and then augmented by collaboration with palliative care specialists. 1
A multidisciplinary team approach improves quality of life, functional status, and reduces hospital readmissions and costs through coordination between primary physicians and specialists, nurse case management, education, and patient and family activation. 2, 4
Common Pitfalls to Avoid
The most critical error is delaying palliative care consultation until end-of-life, which negatively impacts patient outcomes. 2, 4 Early palliative care consultation improves both quality and duration of life. 2
Another common mistake is undertreatment of dyspnea due to unfounded concerns about respiratory depression from opioids—appropriate dosing is safe and effective. 2, 4
Failing to complete advance care planning early in the course of serious illness leads to inadequate end-of-life care and increased suffering. 2, 4
Screening Criteria
The NCCN recommends screening all patients at every visit for: 1
- Uncontrolled symptoms
- Moderate to severe distress related to diagnosis and therapy
- Serious comorbid physical, psychiatric, and psychosocial conditions
- Life expectancy of 6 months or less
- Patient or family concerns about disease course and decision-making
- Specific requests for palliative care