Palliative and Hospice Care: the benefit of end of life care

Although I wrote this years ago, it still is significant today.

Effective end-of-life care includes both palliative and hospice care. The term palliative care is a broad concept, since it includes the management of the physical, psychological, social, spiritual, and existential needs of individuals with advanced disease without reference to a specified life expectancy of the patient. Palliative care is focused on treatment of conditions that are life limiting or refractory to disease-modifying treatment. The term hospice care usually refers to a special type of comprehensive palliative care provided during the last 6 months of life, and is often linked to the specific programs offered under the Medicare hospice benefit. Both palliative care and hospice emphasize the importance of addressing the needs of both these persons and their families (National Hospice Organization Standard and Accreditation Committee, 1997, Task Force on Palliative Care, 1998). This holistic approach to care required by hospice and palliative care, which recognizes the complex and multidimensional needs of patients and families, calls for an interdisciplinary team. Team members typically include nurses, physicians, and social workers, though others may be present, including psychologists, chaplains, pharmacists, dietitians, occupational or physical therapists, and volunteers. Conditions for which hospice and palliative care are appropriate include cancer, AIDS, congestive heart failure, chronic obstructive pulmonary disease, end-stage organ disease, and dementia and other progressive neurological diseases. The goal of hospice and palliative care is to achieve the best possible quality of life for patients and their families. This goal is achieved through relief of suffering, pain and symptom management, psychosocial support, optimization of functional capacity, and respect for autonomy and the appropriate role of family and legal surrogates. While palliative care does not require the exclusion of all aggressive or curative therapies, hospice patients typically must agree to fore go aggressive or curative treatments (though some interventions may be performed to maximize quality of life, such as blood transfusions to maintain energy level in leukemia patients). Specific goals of hospice include self-determined life closure, safe and comfortable dying, and effective grieving (National Hospice Organization Standard and Accreditation Committee, 1997).