Palliative Care
Basics
Palliative care focuses on preventing and alleviating the suffering of patients (and their families) living at any stage of a life-limiting illness.
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
- Consider underlying etiology and treat accordingly.
- 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.)
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Citation
Domino, Frank J., et al., editors. "Palliative Care." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/2.1/Palliative_Care.
Palliative Care. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/2.1/Palliative_Care. Accessed December 1, 2023.
Palliative Care. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/2.1/Palliative_Care
Palliative Care [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 December 01]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/2.1/Palliative_Care.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Palliative Care
ID - 116970
ED - Domino,Frank J,
ED - Baldor,Robert A,
ED - Golding,Jeremy,
ED - Stephens,Mark B,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/2.1/Palliative_Care
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
ER -