Tuesday, February 28, 2012

What is the Difference Between Palliative Care and Hospice?

By Elizabeth Paulk, MD
Specialist in Internal Medicine & Hospice and Palliative Medicine
University of Texas Southwestern Medical Center at Dallas

Palliative Care helps make life as easy as possible for patients and families living with serious illness by addressing the physical, emotional, spiritual and social problems that accompany illnesses like cancer, heart failure, and dementia. It is usually provided by a team that includes doctors, nurses, social workers, chaplains and others, and can be provided in a variety of locations, including hospitals, cancer centers, long-term care facilities and at home. Hospice is a special kind of palliative care for patients who are nearing the end of their lives.

Palliative care spans a continuum that starts with the diagnosis with life-limiting illness and ends with management of caregiver bereavement. A patient and family who have just learned about a diagnosis of advanced cancer, for example, can start receiving palliative care immediately to help treat symptoms and plan for the future. The goal is neither to prolong life nor to shorten it, but to help patients and families define and achieve their goals for however much time is left. This can include treatment of physical symptoms (such as pain and fatigue), emotional stress (such as depression and caregiver burnout), social challenges (identifying local resources for financial or legal assistance, making living wills), and spiritual concerns (for example, coming to peace with the meaning of one’s life). The palliative care continues while they are receiving treatment aimed at the underlying illness (like chemotherapy). Although the goal of palliative care is to improve quality of life rather than quantity, a recent study in the New England Journal of Medicine found that lung cancer patients receiving palliative care early in their treatment not only felt better but lived longer.i

Hospice sits at the far end of the palliative care spectrum, and is a specialized form of intense palliative care provided by dedicated agencies. Patients for whom treatment has become too burdensome or is no longer effective may consider hospice if their physician estimates that they have a life-expectancy of six months or less, and the patient and family agree with a shift in philosophy from disease directed therapy to comfort care. Hospice care provides all the services above and is covered by Medicare and most insurance policies. It also includes access to a nurse 24 hours per day, medications related to the terminal illness, and necessary equipment. Hospice agencies provide bereavement follow up for family members in the event of the patient’s death. Hospice is of proven benefit in terms of symptom management and caregiver supportii but it is not necessarily for everyone. Not all patients and families feel comfortable accepting that time may be limited or want to forgo interventions that may help despite being uncomfortable, and those families may continue to receive non-hospice palliative care indefinitely.

i. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug 19;363(8):733-42.
ii. Twaddle M. Hospice. In: Berger AM, Shuster JL, Von Roenn JH, editors. Principles and practice of palliative care and supportive oncology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p 499-505.

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