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There is a common misperception that palliative care is synonymous with hospice, that it is offered to patients with a terminal prognosis within in a six-month timespan.Palliative care offers support for patients with chronic and serious conditions, as well as their physicians and families, and not solely at the end of life. In fact, the appropriate time to add palliative care to a patient’s healthcare team is at the time of diagnosis.
Palliative care may be provided in the hospital or outpatient setting and is usually physician ordered. Much of the referrals in the hospital are nurse-driven. Following are the important contributions palliative care can make to a patient’s care plan:
Illness Education: Any chronic disease is life changing and patients have questions about how the illness will affect them and their loved ones who will be care providers. For example, a patient receiving a diagnosis of rheumatoid arthritis will wonder if he or she will be crippled or be able to continue to drive. A palliative care provider added to the care team at this point can help clarify what to expect, treatment options, possible effects of therapies and medications.
Symptom Management: The majority of the patient’s healthcare team is focused on disease management and slowing its progress. Palliative care providers are focused on how their disease as well as their treatment may be affecting the patient’s life as a whole. A thorough assessment of their symptoms, including pain, is assessed and addressed from a holistic perspective. The impact of their mental, emotional, social or financial situations are explored that we may treat directly or help to identify outside resources.
Advocating for Patient Rights: I once had a patient with lung cancer who continually missed the tests her care team had scheduled to determine if the disease had metastasized to the brain. Tests were rescheduled to no avail. By speaking with her, we learned she did not want to know if the disease had progressed. Patients appreciate the dedication and hard work of their care teams and don’t want to let them down. Other times, patients may be intimidated to speak up. We serve to enhance the level of communication.
Care Team Collaboration: Patients who have serious conditions have numerous members on their care team including doctors, specialists, nurses and social workers. The overall patient outcome is the priority yet providers often are tasked with just one piece of the puzzle. We can work with the patient and the care team to provide a comprehensive view of the care plan as it progresses.
Optimizing Quality of Life: While most members of the care team ask, “How are you feeling?,” we may ask a patient “What truly brings you meaning?” For example, if a patient wants to spend Thanksgiving at home with family, we can work with the team on how that may be best accomplished. It is our role to help determine how patients and their families are functioning and coping and where we can be of service.
Empowering Decision Making: An informed patient is an empowered patient. We work to make sure a patient understands the care plan and how it will affect his or her life. We then listen to their wishes and help them find the courage and the tools to communicate that to their care team and loved ones.
Looking at palliative care from the bottom line, it increases the quality of care we offer patients while also offering secondary outcomes of reduced readmissions, reduction in the length of stay and the appropriate allocation of services. Looking at it from the heart, palliative care offers a level of service you would want for yourself and your loved ones.
