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 diagnosis.
• 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 often helps to identify the goals of care for the patient based on their 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 or less 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

• 67% of U.S. hospitals with >50 beds reported a palliative care program in data from 2012 to 2013 (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 impaction of stool
  • Diarrhea
  • Dysphagia
  • Mucositis/stomatitis
  • Nausea (and vomiting)
    • Consider underlying etiology and treat accordingly.
      • GI causes: constipation, bowel (full or partial) obstruction, ileus, heart burn, 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
• Sialorrhea
• Xerostomia
• General medical
  • Delirium (40–85%)
• Pulmonary symptoms
  • Cough, chronic
  • 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.)