Palliative Care for Chronic Illnesses

In this informative article, our Director of Education, Martha McCormick discusses new research on Palliative Care and how it can help many struggling with chronic illness.

Compassion, Healing, Science
Until recently even the mention of “palliative care” concerning a sick person might bring a concerned response. A case in point - just last year, a relative was hospitalized due to cancer.While his family was visiting, a representative from the hospital Palliative Care Program stopped by and inquired whether the patient might like a massage or other comfort care. His son was highly offended, inferring that palliative care meant end of life and that the doctors had given up on his father.

The medical definition of “palliation” includes “relieving or masking pain without attempting to cure”. In most hospitals, offering palliative care to patients undergoing curative treatment was a rarity. If you heard of palliative care it almost always concerned trying to keep patients free of suffering at the end of life, often in Hospice care.

The hospice movement and its adoption is teaching us much about palliative care that is now being integrated into curative care. Research on palliative care for chronically ill patients has shown that it can actually improve treatment outcomes. That is, patients who get relief from discomfort and pain, as well as nausea, insomnia, etc., actually do better in treatment. It seems that “no pain - no gain” is not the rule in patient care.

Improving Quality of Life
R. Sean Morrison, MD is Director of the Hertzberg Palliative Care Institute at Mount Sinai Hospital in New York City. He defines Palliative Care as “a relatively new medical specialty that focuses on improving quality of life for people living with serious illness … by addressing symptoms such as pain or nausea; by helping patients and families identify their goals of care and matching treatments to those goals; and by helping to coordinate a terribly fragmented health care system.” He says that “palliative care provides an added layer of support for persons with serious illness and their families in the setting of routine medical care. Most importantly, it is provided at the same time as all other medical treatments, including those to cure disease and those to prolong life.”

Dr. Morrison identifies three important advances in Palliative Care in recent years: the first being rapid growth in hospital palliative care teams - going from less than 5% of hospitals having them to over 85% of mid to large size hospitals now with teams. Second, Palliative Care was recognized in 2006 as an official medical subspecialty. This means metrics for physician practices as well as specific training and standards. Third is agreement and standardization of quality guidelines for palliative care programs. This helps patients and families recognize quality programs.

Who can benefit from Palliative Care? 
The National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care outlines populations likely to benefit including: individuals living with chronic and life threatening injuries from accidents or other traumas, anyone with injuries or conditions leading to dependence on life-sustaining treatments, long-term care and/or support from others to perform daily activities, those with developmental disabilities who develop serious or life threatening illness, those with acute, serious and life-threatening illness where cure is a realistic goal but the condition and treatments result in poor quality of life, those with progressive chronic conditions, seriously and terminally ill patients for whom palliative care is the focus and goal of care for the remainder of life, including vulnerable or underserved populations.

Palliative care addresses patient care from several perspectives including physical (pain, nausea, sleep, etc,) psychological, psychiatric, and social (relationships, family, community, etc.) Spiritual aspects of care include acknowledgement of spirituality and attending to spiritual concerns throughout the illness trajectory. Similarly Cultural aspects of care and palliation are addressed with recognition both of cultural differences and the need for care providers to be culturally literate in their communication and approaches.

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