Palliative Medical Associates for Seriously Ill Patients
What You Need to Know About Palliative Medicine
When your patient is diagnosed with a chronic or life-limiting disease, you work with specialists to cure or control the disease. In the last decade, a new specialty has developed: palliative medicine.
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Palliative medicine is specialized medical care for people with serious illnesses. It provides patients with relief from the symptoms, pain and stress of a serious illness—whatever the diagnosis.
What Are the Goals of Palliative Medicine?
The goal of palliative care is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses and other specialists who work with a patient's primary care physician and other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.
Palliative Care Guidelines
An interdisciplinary palliative care team addresses everything from pain management to crises of faith to weight loss to community resources. They work with newly diagnosed patients and those struggling with the after-effects of curative therapies. Some members of the palliative team may be board certified in hospice and palliative medicine; others range from chaplains to acupuncturists.
A palliative consult with your patient provides timely and specific information that helps the patient and family understand what palliative medicine brings to the table, and helps you provide the most appropriate care.
It is very likely that, if you do not suggest palliative care to your seriously ill patients, they will ask you about it. Here are some FAQs to have handy:
Q. Where can I find a palliative care team?
A. Most hospitals have a palliative specialist on staff. These are physicians and other clinicians who are board certified in hospice and palliative medicine.
Q. Who is on a palliative care team?
A. A doctor, nurse and social worker are the core of most palliative care teams, but expect to find a chaplain, counselor, pharmacist, dietician, physical therapist, rehabilitation specialist, music and art therapists, home health aides and more.
Q. What’s the difference between palliative care and hospice care?
A. Both are holistic and address all the facets that contribute to quality of life. Hospice is palliative medicine for patients for whom curative care is no longer viable and who have a prognosis of six months or less to live.
Q. Who pays for palliative care?
A. Many insurances companies offer palliative benefits. Medicare restricts its coverage to end-of-life care for patients with a prognosis of six months or less who have decided against curative treatment. There are no Medicare regulations or reimbursements for palliative medicine.
Q. What does a palliative team do?
A. Aside from providing comfort care, a palliative care team helps patients communicate with multiple doctors and family members to better understand the disease progression and create a smooth transition between the hospital and home care or a nursing facility. The palliative care team will educate patients and families about what to expect and schedule regular meetings to discuss ongoing care throughout the course of the illness.
Patient Criteria for Palliative Care
Team, patient and/or family needs help with complex decision-making and determination of goals of care:
- Uncertainty of prognosis
- Uncertainty of appropriateness of therapy options
- Uncertainty of end-of-life status and/or hospice appropriateness
Conflicts over care exist:
- Patient and/or family request care that team feels is “futile”
- DNR order conflicts
- Conflict over use of artificial nutrition and hydration in cognitively impaired, seriously ill or dying patient
- Family distress impairing surrogate decision-making
Presence of threshold situation predictive of further deterioration:
- New diagnosis of life-limiting illness
- Declining function with decreased ability to complete activities of daily living
- Unrelenting, unexplained weight loss
- Hospital admission from long term care facility
Patient has unacceptable and uncontrolled symptoms for >24 hours:
- Emotional or spiritual suffering or distress
Hospital/emergency department admissions:
- Patient has presented to the emergency department more than once in one month for the same diagnosis
- Patient has had >2 hospital admissions within 3 months for the same diagnosis
- Patient has a hospital stay of >5 days without evidence of clinical improvement
- Patient has prolonged ICU stay, or >2 ICU transfers on same admission, without evidence of clinical improvement
- Patient in ICU setting with multiorgan failure
- Prolonged or failed attempt to wean from ventilator
- Consideration of rapid weaning from ventilator with expected patient death
- Consideration of transfer of ventilator-dependent patient to long-term ventilation facility
Other clinical criteria that could prompt a palliative care consultation:
- Metastatic cancer with failure of multiple regimens of treatment
- Neurologic complications of cancer
- Brain metastases
- Spinal cord compression
- Carcinomatous meningitis
- Advanced lung disease with frequent exacerbations
- Advanced cardiac disease requiring consideration of LVAD or IV pressors
- Advanced renal disease with deterioration despite dialysis
- Neurodegenerative disease considering feeding tubes or ventilator support
- Anoxic encephalopathy
- Stroke with resultant function decreased by 50 percent, considered life-limiting
- Catastrophic multiple trauma