Description

• The principal goal of palliative care is to prevent and alleviate suffering—whether physical (pain, breathlessness, nausea, etc.), emotional, social, or spiritual regardless of the underlying etiology.
• Palliative care is an interdisciplinary approach to caring for patients and families.
• Palliative care aims to improve or maintain quality of life for patients and families despite serious illness.
• The palliative care team helps to identify goals of care based on patient preferences and values.
• Palliative care is available for patients with serious, life-limiting illness, at any stage of their disease, with or without concurrent curative care. Patients and their families may access palliative care services in the hospital, rehabilitation or skilled nursing facility, and ambulatory setting.
• Hospice: In the United Sates, hospice is available for patients whose average life expectancy is ≤6 months and whose principal goal is to stay at home (including long-term care or assisted living facility), avoid hospitalizations, and forego disease-directed care with a curative intent. Unlike regular home nursing services, hospice does not require a patient to be homebound. Hospice offers backup support for patients 24 hours a day and 7 days per week.

Epidemiology

• Over two-thirds of U.S. hospitals with >50 beds report having a palliative care program (1).
• It is estimated that between 69% and 82% of those who die in high-income countries need palliative care.

Commonly Associated Conditions

Common symptoms/syndromes encountered in palliative care:

• Pain
  • Chronic pain
  • Neuropathic pain
  • Pain from bone metastases
• GI symptoms (~60% incidence)
  • Ascites
  • Anorexia/cachexia
  • Bowel obstruction
  • Constipation and stool impaction
  • Diarrhea
  • Dysphagia
  • Mucositis/stomatitis
  • Nausea (and vomiting)
    • Consider underlying etiology and treat accordingly.
      • GI causes: constipation, bowel (full or partial) obstruction, ileus, reflux, inflammation
      • Intrathoracic causes: cardiac, effusions (cardiac, pulmonary), mediastinal causes, esophageal disease
      • Autonomic dysfunction
      • Centrally mediated: intracranial pressure change, inflammation, cerebellar, vestibular, medication or metabolic cause stimulating vomiting center, and/or chemoreceptor trigger zone
      • Medication side effects
• Sialorrhea
• Xerostomia
• General medical
  • Delirium (40–85%)
  • Fatigue
• Pulmonary symptoms
  • Cough
  • Breathlessness or dyspnea (60%): which may be due to heart failure, COPD, lung cancer, etc.
• Psychological symptoms
  • Anxiety
  • Depression
  • Insomnia
• Skin
  • Decubitus ulcer
  • Pruritus
  • Complex wounds (fungating tumors, etc.)