Palliative care refers to therapy that treats the symptoms of people living with serious illnesses.
This type of care focuses on providing relief from symptoms and improving the quality of life, rather than extending a patient’s life. Examples of palliative care range from pain management to chemotherapy used for palliative purposes. Most often, palliative care is administered through hospices or certain bridge programs.
Hospice Care
Hospices provide care for patients when they typically have six months or less left to live. They are designed to provide comfort for a patient at the end of his or her life, as opposed to therapy that cures or extends the patient’s life. Depending on the hospice, this care may be provided in the patient’s home, special hospital units, or other settings. Support services provided by hospice care typically involve pain management, which may be administered at higher than normal doses, psychological and spiritual counseling services for patients and their caregivers, and help to perform daily needs, such as getting dressed.
Not all hospices provide the same type of palliative care or life support therapy. One study evaluated 100 hospices and found that 48% would deny patients admission if they wanted to receive palliative chemotherapy, 36% would deny patients if they wanted to receive palliative radiation therapy, and 38% would deny patients if they wanted to receive nutrition through a feeding tube or intravenous therapy.
If a patient wishes to receive life support therapy or another form of palliative care, they should choose a hospice based on whether it will allow them to receive that therapy. If a hospice will not admit a patient based on policies, they may consider finding a hospice that provides an open access model. These hospices allow patients access to certain types of palliative care.
Questions to Keep in Mind
Since hospices vary in setting, the number of staff members, and the type of services provided, it is important to reflect on the following questions when selecting the best hospice program.
- What are the patient’s end-of-life desires and what are the desires of important members of their support group, such as their family?
- Where does the patient wish to die?
- What type of services will the patient likely need or want at the end of their life?
- Does the patient want to receive palliative care or life support therapy, such as palliative chemotherapy, or receive nutrition intravenously?
- If the patient would like to receive palliative care that is not permitted at local hospices, can they be admitted to an open-access hospice program?
Other Options: Bridge Program
Some patients want to participate in day-to-day activities at home, and/or continue to receive certain types of palliative care that would not be allowed in some hospices. As such, these patients may decide not to enter a hospice at the end of their life.
If a patient decides not to enter hospice, they may want to consider having a palliative care consultation. For example, it could be helpful to determine whether a patient can obtain pain management, especially near the end of their life. The patient may also want to consider identifying a bridge program. Bridge programs provide palliative care, and some will even provide this in a home setting.
Conclusion
End-of-life decisions are very personal and depend on a variety of factors unique to each person’s situation. The patient should involve their loved ones in these decisions, but the choices are ultimately theirs to make. Coping with the end of life is likely to be the most emotionally difficult situation a person has ever experienced, so they should be encouraged to seek out whatever support will help them and their loved ones through this time.
