March 20, 2019
3 Things to Know About Palliative Care

3 Things to Know About Palliative Care

by Keng Lam, MD  

Prior to the 1960s, the comfort a dying or seriously ill patient received was largely dependent upon the caring and expertise of their physician; no standard existed to ensure that such patients would be provided relief of pain and other symptoms once it became clear that their underlying condition couldn’t be cured.

That changed in 1967, when a British physician named Cicely Saunders created the first modern hospice in London, called St. Christopher’s. Still operating today, Saunders’ facility was dedicated to providing symptomatic relief to all dying patients, using a holistic model that focused on managing pain and other discomfort patients might experience at the end of life.

Saunders is also credited with introducing this specialized form of care to the United States in a series of lectures to nursing and medical students, social workers, and chaplains at Yale University in 1963. The opening of the first hospice in the U.S., the Connecticut Hospice, followed in 1974, providing home and inpatient hospice services to terminally ill patients.

Since then, hospice has become a subset of a larger movement in Western medicine called palliative care—a general term for assuring the physical, emotional, social, and spiritual comfort of a person with serious medical problems. By the 1980s, hospice and palliative medicine had become its own medical subspecialty in which American physicians could become board-certified. Today, about 7,500 physicians in the United States hold certification in hospice and palliative medicine, according to the American Academy of Hospice and Palliative Medicine.

Here are three things to know about palliative care, which has continued to evolve over time. (In a future article, we’ll focus specifically on hospice care.)

1. It’s not just for the end of life.

It is no longer the case that one must be reaching the end of life before being qualified to receive palliative treatment. While hospice care focuses on patients with life expectancy of six months or less, palliative teams care for patients of all ages who are at various stages of serious illnesses such as cancer, kidney failure, and neurodegenerative conditions.

A palliative care team is generally an interdisciplinary group consisting of doctors, nurses, social workers, and pastoral staff. Their focus includes, but is not limited to, helping patients manage symptoms such as pain, nausea, dry mouth (resulting from their illness or medications), and insomnia, as well as providing spiritual and emotional support.

2. It’s not a replacement for other treatments.

Contrary to popular belief, one does not have to give up curative treatment in order to be evaluated and treated by a palliative care team. Often, a patient will receive concurrent care from a specialist such as an oncologist while also being visited by a palliative-care team to address symptom control.

It can be useful to have palliative specialists intervene earlier in treatment rather than later, since they can both help patients to better understand their illness and identify what is most important to them as they go through the remainder of their treatment (for example, balancing the potential life-extending benefits of certain treatments against the effect they may have on the patient’s quality of life). Most hospitals offer palliative services, and most insurance plans cover them. (If you’re not sure, check with your plan.)

3. There’s evidence to back its efficacy, though more studies are needed.

In a randomized controlled trial of 150 patients with advanced heart failure, published in 2017 in the Journal of the American College of Cardiology, those who received palliative interventions in addition to the usual medical care had significantly greater improvements in quality of life, depression, anxiety, and spiritual well-being after six months compared with the group who received usual care only.

In a systematic Cochrane review published in 2017, investigators analyzed seven clinical trials of palliative care in adults with advanced cancer, involving a total of 1,614 participants. They concluded that “early palliative care interventions may have more beneficial effects on quality of life and symptom intensity among patients with advanced cancer” compared with usual care alone. Though the effect sizes were small, the authors pointed out that “these may be clinically relevant at an advanced disease stage with limited prognosis, at which time further decline in quality of life is very common.”

The authors also noted that six of the seven studies reported no side effects from the interventions, and that an additional 20 trials of palliative interventions in cancer patients were ongoing—which could provide more evidence and increase the certainty of the results.

Bottom line: If you are diagnosed with a serious medical condition, consider talking to your doctor about a referral to a palliative-care specialist. If you want to learn more about palliative care, good sources include GetPalliativeCare.org and CaringInfo.org.

Also see Do You Have an Advance Care Directive?