What is palliative care?

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, and culture—delivered concurrently with disease-directed therapies from the time of diagnosis, regardless of prognosis or disease stage. 1

Core Definition and Philosophy

Palliative care represents both a philosophy of care and an organized, highly structured system for delivering care to persons with life-threatening or debilitating illness. 1 The fundamental goal is to prevent and relieve suffering while supporting the best possible quality of life for patients and their families. 1

Palliative care begins at diagnosis and continues throughout the entire disease trajectory—it does not represent a transition away from curative treatment. 2 Patients can and should receive palliative care while simultaneously undergoing chemotherapy, radiation, dialysis, mechanical ventilation, or any other disease-modifying treatment. 1, 2, 3

Key Distinguishing Features

Timing of Initiation

• Palliative care should be initiated as soon as patients with serious illness develop symptoms, not reserved for end-of-life care. 1, 2 The intensity of palliative services adjusts to match patient and family needs—intensifying during acute exacerbations, peaking at the time of death, and extending into the bereavement period. 2

• The traditional dichotomous model (curative care first, then palliative care) has been replaced by an integrated model where palliative care runs concurrently with curative/restorative care from diagnosis onward. 1

Distinction from Hospice Care

• Palliative care does not require any specific prognosis and can be provided alongside curative interventions, while hospice care requires physician certification of a terminal prognosis (more likely than not less than 6 months to live) and mandates cessation of disease-directed treatments. 3, 4

• Hospice operates under the Medicare Hospice Benefit and requires patients to agree in writing that only hospice services will be used to treat their terminal illness, discontinuing disease-directed treatments in favor of pure comfort measures. 3

Core Components of Palliative Care

Physical Symptom Management

The primary oncology or medical team should screen all patients at every visit for: 1

• Uncontrolled pain, dyspnea, nausea, vomiting, constipation, fatigue, weakness, insomnia, and delirium 1, 2
• Moderate to severe distress related to diagnosis and therapy 1
• Serious comorbid physical, psychiatric, and psychosocial conditions 1
• Life expectancy of 6 months or less 1
• Patient or family concerns about disease course and decision-making 1
• Specific requests for palliative care by the patient or family 1

Psychosocial and Spiritual Care

• Assessment must focus on illness-related distress, depression, anxiety, and existential concerns in all patients. 1, 2
• Cultural, spiritual, and family-dynamic factors must be incorporated into the care plan. 1, 2
• Caregivers should be routinely screened for practical and emotional needs. 2

Communication and Advance Care Planning

• Advance-care-planning conversations must begin early in the disease course—delaying these discussions until imminent death worsens outcomes. 2
• Discussions should explore goals of care, weighing quality of life against length of life, and evaluate the appropriateness of interventions such as feeding tubes, hydration, ICU admission, mechanical ventilation, and CPR. 2
• The benefits and risks of disease-directed therapies must be reviewed in the context of the disease's natural history, potential response, toxicity profile, and comorbidities. 1, 2

Interdisciplinary Team Approach

A core palliative-care team must include physicians, nurses, social workers, chaplains, and other health professionals who work collaboratively. 2 Primary oncology or medical teams deliver initial palliative support, with specialist palliative-care consultation added when the complexity of symptoms or decision-making exceeds routine capacity. 2

All team members should be competent in symptom management, prognostication, communication, and advance-care planning. 2

Family-Centered Care and Bereavement

• Palliative care offers a support system to help families cope during the patient's illness and with their own bereavement. 1
• Bereavement support begins before death and continues for up to one year afterward. 2
• The psychological and emotional needs of both family members and professional caregivers must be acknowledged and supported. 1, 2

Common Pitfalls to Avoid

• Do not delay palliative-care consultation until end-of-life—initiate consultation early to improve quality and duration of life. 2
• Do not withhold palliative care while providing curative treatment—deliver palliative and curative therapies concurrently from diagnosis. 1, 2, 3
• Do not assume palliative care requires a ≤6-month prognosis—the 6-month criterion applies only to hospice eligibility, not to palliative-care eligibility. 2, 3
• Do not fail to complete advance-care planning early—conduct these discussions promptly to ensure care aligns with patient wishes. 2

Standards of Care

• Institutions should develop a process ensuring that all patients have access to palliative care services from the initial visit. 1
• All cancer patients should be screened for palliative care needs. 1
• Palliative care should be initiated by the primary oncology or medical team and then augmented by collaboration with an interdisciplinary team of palliative care experts. 1