How you or a loved one want to live the last part of life is not easy to think about.
Something to consider, though, is learning the benefit of palliative medicine, a holistic approach to care that offers support so patients and their families can have the best quality of life possible at that point in life.
“In palliative medicine, we help the person and their family members with the serious medical illness they face,” said Dr. Ajit Abraham, a Marshfield Clinic Health System palliative medicine specialist. “We manage disease symptoms, providing care that includes physical, emotional, social and spiritual support with the goal to control pain and other symptoms as well as provide emotional and spiritual support to the patient and family.”
“Palliative” comes from the Latin “pallium” which means “cloak,” Abraham explained. “That’s how the specialty began in the United Kingdom by Dame Cicely Saunders, since it was meant to palliate or cloak symptoms and provide comfort.”
Palliative medicine is comprised of palliative care and hospice, with similarities and differences that are important to know.
Inpatient palliative care
This care is for patients who have serious and potentially life-limiting illness. It provides relief from symptoms and psychosocial as well as spiritual support. An interdisciplinary team provides this care and includes a physician and nurse practitioner, social worker and chaplain. Care begins at the discretion of the patient and physician and is typically given in a hospital setting.
“We also help patients and families with complex medical decision-making and formulating a plan of care that aligns with their goals,” Abraham said. “Some hospitals have palliative care units, like Marshfield Medical Center, where this care is usually delivered.”
Outpatient palliative care
This care is provided in the outpatient clinic setting, next to the Oncology Department at the Marshfield Medical Center and via Telehealth from other Health System sites. Care is led by a physician and nurse practitioner with access to a social worker and it’s similar to that provided in the hospital.
Also, care is given in collaboration with other medical specialists, like those who treat cancer and chronic illnesses like COPD, heart failure, dementia, end-stage renal disease and neurological diseases like ALS.
This care is for patients with a terminal illness, defined as a prognosis of less than six months to live. Treatment to cure or control disease has stopped. The focus is compassionate comfort care, typically in the home or facilities like assisted living or nursing homes.
Hospital care is no longer an option unless it’s needed to provide better symptom management and comfort due to failure of the plan at home.
Two physicians are required to certify the patient’s life expectancy. A core team – a physician, nurse practitioner, hospice nurse, social worker and chaplain – oversees care, meeting every other week to review patients’ plans; nurses’ aides help patients with daily living tasks; and volunteers help as needed. A hospice nurse is available 24/7 for problems that arise and makes regular home visits though frequency varies depending on care needs.
Pediatric palliative care
Children and youth under age 18 may benefit from pediatric palliative care as soon as a serious illness is diagnosed. A young patient can start with hospice care but, unlike adults, can continue to be hospitalized for treatment should they wish, even if they have a life expectancy of six months or less.
“We get involved when a patient has a serious complicated medical issue that has a complicated treatment plan or a strong chance of treatment failure,” Abraham said. “We help people face that situation and navigate the process.
“We try to coordinate it all, to make clear to patients and families about care plans and treatment options while weighing risks and benefits. We help them make the best decision aligning with their goals in life as closely as possible.”
Palliative medicine’s core interdisciplinary team includes:
- Physicians and nurses who address pain and symptom management.
- Social workers who provide social and emotional support and help connect patients to community services, especially patients with financial difficulty because of medical costs.
- Chaplains for spiritual support.
- Additional team members like pharmacists, dietitians, massage and music therapists, counselors, psychologists and volunteers can be part of the team.
“This team-based approach is helpful since many factors can come into play,” Abraham said. For example, “a patient may have more physical symptoms, like pain because of deep emotional trauma or spiritual angst, that when addressed helps the physical pain also get better.
“We strive to help with the whole picture of what’s distressing to the patient and family as they face a serious life-limiting illness.”