Palliative Care Definition
Palliative care is an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems—physical, psychosocial, and spiritual. 1
Core Components of Palliative Care
The World Health Organization's definition, endorsed by the American Thoracic Society, establishes that palliative care encompasses several essential elements 1:
- Provides relief from pain and other distressing symptoms through systematic assessment and management 1
- Affirms life and regards dying as a normal process, neither hastening nor postponing death 1
- Integrates psychological and spiritual aspects of patient care alongside physical symptom management 1
- Offers a support system to help patients live as actively as possible until death, maintaining quality of life throughout the disease trajectory 1
- Extends support to families during the patient's illness and continues through bereavement care after death 1, 2
Critical Timing and Integration
Palliative care should begin at diagnosis and be delivered concurrently with disease-directed, life-prolonging therapies—not reserved only for end-of-life situations. 1, 2 This represents a fundamental shift from the outdated dichotomous model where palliative care only began after curative treatments failed. 1
The American Thoracic Society explicitly states that palliative care should be provided throughout any stage of illness—acute, chronic, or terminal—with the intensity individualized to meet patient and family needs. 1, 2 This means patients can receive chemotherapy, radiation, dialysis, or other disease-modifying treatments while simultaneously receiving palliative care services. 3
Patient and Family-Centered Approach
Palliative care is fundamentally patient- and family-centered, incorporating the needs, values, beliefs, and cultures of both parties. 1, 2 The National Comprehensive Cancer Network emphasizes that families are not merely bystanders but active participants requiring their own understanding and support throughout the disease trajectory. 2
Key family-centered elements include 1, 2:
- Bereavement counseling and support that extends beyond the patient's death
- Shared decision-making involving patients, families, and the healthcare team
- Cultural and spiritual sensitivity respecting diverse beliefs and practices
Distinction from Hospice Care
A critical distinction: palliative care is NOT synonymous with hospice. 4, 3 Hospice is a subset of palliative care reserved for patients with a prognosis of 6 months or less who choose to forgo disease-directed treatment and focus exclusively on comfort measures. 4, 3 In contrast, palliative care can and should be provided alongside curative treatments from the time of diagnosis. 1, 3
Screening and Access
All patients should be screened at every visit for palliative care needs, including 1, 4:
- Uncontrolled physical symptoms (pain, dyspnea, nausea, fatigue)
- Moderate to severe emotional distress related to diagnosis
- Serious comorbid conditions
- Life expectancy of 6 months or less
- Patient or family concerns about disease course and decision-making
- Specific requests for palliative care services
Multidisciplinary Team Approach
Palliative care requires a team-based approach involving physicians, nurses, social workers, chaplains, and other specialists working collaboratively to address the multifaceted needs of patients and families. 1 This interdisciplinary structure ensures comprehensive assessment and management across physical, psychological, social, and spiritual domains. 1