Introduction

Palliative Care is a relatively new field of medicine born out of the hospice movement.

The Center to Advance Palliative Care (CAPC) defines palliative care as “specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.” Palliative care is provided by a specially trained team. Palliative care specialists work together with a patient’s other clinicians to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any point in a serious illness and can be delivered at the same time as curative treatment.

The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem 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.” They add that palliative care:

• provides relief from pain and other distressing symptoms

• affirms life and regards dying as a normal process

• intends neither to hasten or postpone death

• integrates the psychological and spiritual aspects of patient care

• offers a support system to help patients live as actively as possible until death

• offers a support system to help the family cope during the patient’s illness and in their own bereavement

• uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated

• will enhance quality of life and may also positively influence the course of illness

• is applicable early in the course of illness; in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy; and includes those investigations needed to better understand and manage distressing clinical complications
  
  

The palliative care rotation may differ from other rotations. Most palliative care services work as an interdisciplinary team that may include physicians, nurse practitioners, physician assistants, social workers, and chaplains. This diverse team can provide whole-person care, which is crucial for patients with serious illness. While medical clinicians may focus more on the medical aspects of care and the social workers and chaplains more on the psychosocial and spiritual aspects, all team members practice transdisciplinary care such that the medical clinician will discuss psychosocial and spiritual issues and the social worker or chaplain may assess pain or nausea. Referring teams call palliative care consults for many reasons, including symptom management, goals of care, or end-of-life care. Another aspect that may feel new is the amount of suffering that palliative care teams witness on a daily basis. It is normal to find this rotation emotional or tiring in a different way. You will also learn coping strategies that palliative care teams implement, including reflection on patient interactions, mutual support of team members, and memorializing each patient that dies, among others.

This guide covers the following topics:

• Core Principles of Palliative Care Practice

• Pain Management

• Nausea and Vomiting

• Dyspnea

• Care of the Imminently Dying Patient

• Discussing Goals of Care and Prognosis

• Ethical Issues

• Hospice Care
  
  

Other topics related to palliative care are covered in the following rotation guides:

• Delivering Bad News (Patient Communication)

• Delirium (Geriatrics, Critical Care)

• Depression (Mental Health)

• Anxiety (Mental Health)

• Symptom Management (Oncology)