Health & Medicine

Palliative care helps define goals of care for terminally-ill patients

Beyond needed medications and treatments, chronic or terminal illnesses can be taxing on a patient's body and mind. Palliative care is a way to manage symptoms and help patients improve their quality of life. Palliative care doesn't treat a specific illness, but rather allows a patient to define goals of care for themselves, in concert with a team of physicians, nurses and social workers.

In general, anyone with a chronic or terminal illness is appropriate for palliative care, including those with heart failure, kidney disease on dialysis, or those with end-stage lung disease. Oftentimes, the patients needing it the most are end-stage cancer patients that require help controlling their symptoms, clarifying the goals of their care and finding relief from any side effects of their medication.

The goal is to help the patient live through the difficult period in minimal discomfort and in full engagement with their care plan.

Patients with a chronic illness will be referred to palliative care by their physician. On the day of their visit, they'll be seen by an entire team of professionals, including a physician, nurse and social worker, to ensure there is a clear baseline of what's going on, what symptoms they see as problematic and to determine goals for care.

The palliative care team will then help determine what's needed to manage the patient's symptoms and make their lives more comfortable.

Patients come in with all types of symptoms depending on their condition. For those with cancer, the most common symptoms are pain, fatigue, anxiety and depression, and loss of appetite or nutrition issues. In some cases, the palliative care physician may prescribe medications to stimulate the appetite or ease fatigue, or consult a nutritionist to ensure that nutrition needs are met.

Patients with pain may receive medications or physical therapy to help ease that symptom. For patients with anxiety or depression, extremely common for patients with terminal illness, the physician may refer the patient to a psychologist or psychiatrist and to work with their assigned social worker to help remedy the problem.

For a cancer patient, the palliative care physician is not directing their treatment as their oncologist would, but rather, is there to provide a different set of eyes and ears. The physician and care team provide the patient a chance to address issues they may not normally have the time to address with their oncologist because symptom control isn't always top of mind when undergoing chemotherapy or radiation.

Perhaps most importantly the palliative care team will help the patient consider their options and define the goals they want to achieve from their care. For example, an oncologist may recommend a new treatment that carries the risk of serious side effects, yet a palliative care physician will help the patient consider the risk and benefits of treatments. Together, the oncologist, palliative care physician and patient can make informed decisions for quality care and quality of life.

Though terminal illness can leave an individual and family with many questions and concerns, a palliative care team can discuss these concerns in a welcoming environment.

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