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Palliative Care

Palliative Care is a topic covered in the 5-Minute Clinical Consult.

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Basics

Palliative care is a specialty that focuses on preventing and alleviating suffering of patients (and their families) living with life-limiting illness at any stage.

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 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.
  • 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 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 and offers backup support for patients 24 hours a day and 7 days per week.

Commonly Associated Conditions

Common symptoms/syndromes in palliative care:

  • Pain
    • Chronic pain
    • Headache
    • Neuropathic pain
    • Pain from bone metastases
  • GI symptoms (~60% incidence)
    • Ascites
    • Anorexia/cachexia
    • 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
    • Bowel obstruction
    • Constipation and impaction of stool
    • Diarrhea
    • Dysphagia
    • Mucositis/stomatitis
    • Sialorrhea
  • 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.)

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Citation

Stephens, Mark B., et al., editors. "Palliative Care." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/all/Palliative_Care.
Palliative Care. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/all/Palliative_Care. Accessed August 21, 2019.
Palliative Care. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/all/Palliative_Care
Palliative Care [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 August 21]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/all/Palliative_Care.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Palliative Care ID - 116970 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116970/all/Palliative_Care PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -