Palliative Care

Palliative care is comprehensive, holistic care that concentrates on improving quality of life rather than on curing disease. The term palliative is derived from the Latin palliare, meaning to cloak. It encompasses hospice end-of-life care but is not limited to it. Palliative care is used along with treatment of disease in some situations.

In the broadest sense palliation applies to any situation when the treatment of symptoms is the focus. For instance, there is no cure for the common cold, and treatment is for relief of symptoms. Similarly, physical therapy, applications of heat and cold, and pain medications are palliative for back pain but not curative. In practice, however, the term palliative care refers to relieving suffering and improving the quality of life of patients experiencing life-threatening or life-limiting complex, serious illness. Palliative care is appropriate for patients at any stage of illness.

History

Palliative care has been part of health care for centuries. In the 4th century C.E., early Christians were known for providing hospice care to injured travelers and the seriously ill and dying. Fabiola, a Roman noblewoman, provided financial support and served as a nurse in hospice care and gave impetus to the movement.

The modern palliative care movement began in the mid-1960s. Dame Cicely Saunders established St. Christopher's Hospice for the care of the terminally ill in England in 1967. Her focus was relief of suffering and compassionate support for patients at the end of life. The hospice movement began in the United States in 1974 through the communitybased home care program in New Haven, Connecticut. The first hospital palliative care program was also established in 1974, at St. Luke's Hospital in New York City. The hospice and palliative care programs focused on relief of pain and other symptoms as well as the emotional and spiritual concerns of dying patients and their families. More hospital-based palliative care programs began in the 1980s. Since then, the number has increased to more than 1,200. Over half of U.S. hospitals with 100 beds or more have a palliative care program.

The American Academy of Hospice and Palliative Care Medicine was established in 1988 to provide certification and continuing education for physicians who are in palliative care. The academy's focus is the “science of comfort and the art of caring” in life-limiting or chronic illness. In the early days, physicians in the palliative care movement often felt as if they were second-class citizens among their medical colleagues. Hospice and palliative care medicine is now an established subspecialty in medicine.

Care Recipients

Palliative care may be delivered in the hospital, nursing home, in-patient hospice, or at home. The patient and family are the recipients of care and are at the center of the health care delivery model. [Page 796]Programs are available for patients of all ages, including children, and at any stage of illness. The care providers work together as a team to help relieve suffering and improve quality of life.

Patients with complex, life-threatening, or lifelimiting illnesses are the recipients of care. Some of the medical diagnoses are cancer, cardiovascular disease, respiratory disease, kidney failure, Parkinson's disease, Alzheimer's disease, AIDS, amyotrophic lateral sclerosis, and multiple sclerosis. When patients are referred for hospice palliative care, they have approximately 6 months or less to live; the most common diagnosis among these patients is cancer. Other patients receiving palliative care may be receiving therapies for the underlying diagnosis simultaneously. The common factor with hospice and nonhospice palliative care patients is that they have complex health problems and can benefit from holistic, compassionate relief of physical, psychosocial, and spiritual suffering.

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