Palliative care has been shown to reduce symptom burden, improve psychosocial well-being and reduce healthcare utilization and cost for patients with serious illness. In some studies, early involvement of palliative care was found to help patients to live longer. If hospital or ambulatory palliative care services are available in your area, consider recommending this type of care for appropriate patients.
A Reintroduction to Palliative Care
One of the central tenets of palliative care is to improve the quality of life of those with serious illness. Many lay people, and even some healthcare practitioners, associate palliative care with end-of-life and hospice care. While palliative care specialists have training in end-of-life and hospice care, palliative care encompasses more than that. At its core, palliative care is about helping patients and their families live as meaningfully as possible with serious illness. This is accomplished by a comprehensive whole-person approach to care, targeting all causes of suffering from the physical to the emotional and spiritual.
Palliative care providers, usually physicians or nurse practitioners, work in interdisciplinary teams with social workers and chaplains, and often additional team members, to give comprehensive care to patients and families. Palliative care is most likely to be found in inpatient settings where acuity is higher and end-of-life issues are more prevalent. This has contributed to the idea that palliative care is synonymous with end-of-life care.
Currently, palliative care is also being delivered in non-traditional settings such as outpatient clinics, homes in the community, and long-term care facilities. With ambulatory palliative care, patients receive assistance with:
- Physical symptoms related to disease and treatment toxicities
- Emotional distress
- Coordination of care and advance care planning
In the non-acute setting, advance care planning focuses on assessing patients’ understanding of their illnesses, appointing surrogate decision makers, and participating in values-guided discussions of treatment preferences.
What Constitutes a “Serious Illness”?
A serious illness is any single disease or combination of diseases that could be fatal and that adversely affects a person’s physical, emotional or psychosocial well-being. Common serious illnesses include:
- Progressive organ failure (such as cardiac, pulmonary or renal)
- Neurological disease (such as advanced dementia, amyotrophic lateral sclerosis or serious stroke)
- Cancer (both solid and hematologic malignancies at any stage of disease)
- Advanced vascular disease
- Uncontrolled HIV infection
- Genetic conditions that are life-limiting
It is important to note that even if a serious illness has the potential for cure such as early stage cancer with definitive treatment or renal failure with renal transplant, referral to palliative care for the duration of treatment may be appropriate. Age is not a criterion for palliative care, and patients ranging from infancy to geriatrics may be referred as long as they have an active serious illness.
Which Illnesses Are Not Appropriate for Palliative Care Referrals?
Patients with chronic conditions that are not life-limiting, even if they cause significant suffering, are not appropriate referrals for palliative care. These include chronic pain conditions such as degenerative arthritis, spinal stenosis, fibromyalgia, and chronic psychiatric conditions such as depression and anxiety, bipolar disorder, or personality disorder phenotypes. These conditions can lead to meaningful disturbances in quality of life, and patients are better served by referral to the appropriate specialists who have training in dealing with such chronic conditions.
Additionally, patients who have achieved either cure from a serious illness, such as cancer, or stable disease control may develop chronic symptoms related to prior disease (such as chronic neck pain or dysphagia in head and neck cancer patients). These patients, who may live for years and even decades with such chronic symptoms, would also be better served by referral to the appropriate specialists who may be able to offer targeted therapeutics and monitoring of symptoms.
When Should a Referral to Palliative Care Be Made?
If you have any patients under your care who have a serious illness and appear to be suffering in any way, consider referring them to ambulatory palliative care. Even if there is no established palliative care practice at your institution, there may be palliative care practices in your community or as part of local hospice agencies (distinct from hospice care) that you may discover with an internet search. If there are no palliative care services within reach, consider advocating for this service for your patients and the community at large. Serious illness is ubiquitous, and everyone suffering from it deserves access to the inclusive and personalized care that palliative care affords.
Educational Resources for LAMMICO Insureds
Although palliative care can be offered for many situations, it is often closely associated with end-of-life care. To assist our insureds in guiding their patients at the end of life, LAMMICO offers its insureds complimentary access to the two-part “End of Life” education series through our subsidiary, Medical Interactive Community. The focus of Part I, “End of Life, Part 1: Fostering Discussions and Facilitating Preferences,” is to help healthcare providers aid patients in becoming more capable of talking about and planning for death. In Part II, “End of Life, Part 2: Patient Perspective,” healthcare practitioners can learn from a conversation between a terminal patient and his wife on how to alleviate patients’ distress and expand their comfort at the end of life.
LAMMICO insureds can access this series at no cost by logging in at lammico.com and selecting “Online Education & Webinars from the drop-down menu under their name.
For more information about online education, please contact the LAMMICO Risk Management and Patient Safety Department at 800.452.2120 or 504.841.5211.
Dr. Afezolli, a palliative care physician, is an assistant professor of geriatrics and palliative medicine at Icahn School of Medicine at Mount Sinai Medical Center in New York, NY.