Dr Saheb Sahu, FAAP, MPH
“Death is an inevitable aspect of human condition. Dying badly is not” – Hasting Center Report, 2003.
What is Palliative Care?
Palliative care (from Latin palliare, to cloak) or comfort care is specialized medical approach focused on providing relief from the symptoms, pain, and stress of serious illnesses. Its goal is to improve the quality of life for both the patient and their family. This type of care is appropriate for patients at any stage of a serious illness and can be provided alongside curative treatments. It addresses physical, emotional, and spiritual needs through a multidisciplinary team approach, ensuring comprehensive support tailored to individual preferences and needs.
What is Hospice care?
Hospice care is a type of palliative care specifically for patients who are in the final stages of a terminal illness, typically with a life expectancy of six months or less (US Medicare Law). The primary goal of hospice care is to ensure comfort and quality of life rather than to cure the disease. Like palliative care, hospice care is provided by a team of professionals including doctors, nurses, social workers and chaplains. Hospice care can be viewed as a subset of palliative care with a specific focus on end-of –life.
Global prospective
The present status of palliative care around the world reveals significant disparities and unmet needs, especially in low and middle income countries. Globally, an estimated, 56.8 million people, including 25.7 million in their last year of life, require palliative care. However, only 14% of those in need actually receive it (WHO).
One of the main challenges is the lack of integration of palliative care into national health systems. Many countries do not have any adequate policies, programs, or resources dedicated to palliative care. Furthermore, there is a shortage of trained health professionals and lack of access to medicines like morphine for pain management, because of overly stringent regulations.
When can I start palliative care?
You can start palliative care at any stage of your illness, even as soon as you receive a diagnosis and begin treatment. You do not have wait until your disease has reached an advance stage or when you are in the final months of life. In fact earlier you start palliative care, the better. Anxiety, depression, fatigue, and pain can set in at the beginning of treatment for possibly fatal illness. Talk to your doctor about a referral for palliative care. In most cases, patients receive palliative care in a hospital setting, but services can be delivered in a patient’s home, a hospice, or a long-term care facility.
What diseases can be treated with palliative care?
Originally palliative care was developed for people with terminal illness. But today, patients with cancer, heart disease, chronic lung disease, dementia, multiple sclerosis (MS), and amyotrophic lateral sclerosis (ALS). Parkinson’s disease and many other serious illnesses are eligible for palliative care.
What kind of symptoms palliative care may address?
One of the primary goals of palliative care is symptom management. The disease itself may cause symptoms, but so can treatment. For example, chemotherapy drugs and radiation can cause nausea and vomiting. Narcotics can cause constipation. By providing relief to your symptoms, palliative care can improve your quality of life.
Here are some of the symptoms that palliative care may be able to address.
- . Pain
- .Constipation
- . Nausea and vomiting
- . Diarrhea
- . Bowel and bladder problems
- . Loss of appetite, weight loss, or wasting
- . Shortness of breath or labored breathing
- .Coughing
- . Depression
- . Delirium or mental confusion
- . Weakness
- . Sleep problems.
Conclusion
Starting palliative care earlier can significantly improve the quality of life for patients with serious illnesses. Palliative care can provide comprehensive symptom management including pain relief, emotional and spiritual support, and reduce unnecessary hospitalizations, invasive and sometimes unnecessary treatments. By integrating palliative care sooner, patients and their families gain more time to focus on meaningful activities and better manage the challenges of serious illness, ultimately leading to a better end-of-life experience (Denworth) .
1- Lydia Denworth. Starting Palliative Care Sooner. Scientific American. June, 2024.
2- National Institute of Aging. https://www.nia.nih.gov/
3- https://getpalliativecare.org/
4– World Health Organization. Implementing World Health Assembly Resolution on Palliative care. 12 Oct, 2021
