Palliative Care Different Methods of Treatment

Palliative Care for Terminal and Non-Terminal Patients

Although palliative care is sometimes viewed as a synonym for care for patients with terminal illnesses, a wide variety of different types of patients can benefit from palliative care. "Palliative care is an interdisciplinary medical specialty that focuses on preventing and relieving suffering and on supporting the best possible quality of life for patients and their families facing serious illness" (Meier, McCormick, & Arnold 2015). Palliative care can operate in conjunction with curative methods for non-terminal patients, such as patients experiencing chronic pain, or can be used with patients suffering from terminal illness to make end-of-life care for themselves and their families less painful physically and psychologically. WHO defines palliative care as: "An approach that improves the quality of life ... through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual" (Meier, McCormick, & Arnold 2015).

Palliative care focuses on relief of symptoms versus curing disease. For example, a patient with lung cancer might be prescribed chemotherapy, a treatment which can be extremely stressful in its own right, to cure the disease. Palliative care or pain treatment may be prescribed in conjunction with this treatment to relieve symptoms or, if the patient does not elect to receive treatment, in lieu of this. Regardless of the patient's prognosis, evidence indicates that palliative care can still be beneficial. In a randomized control study of patients with metastatic non -- small cell lung cancer, the group that received palliative care "integrated with standard oncologic care had a better quality of life (QOL), less depressive symptoms, and longer median survival than did those who were assigned to oncologic care alone" (Meier, McCormick, & Arnold 2015).

For terminally ill patients, palliative therapy may include in addition to symptom management counseling about end-of-life issues. For non-terminally ill patients, counseling is still relevant but may include information about pain management and how to live with chronic medical conditions. An important component of the treatment of both groups of patients is managing depression which has "a prevalence rate of 15 to 60% in patients with a terminal illness" (Meier, McCormick, & Arnold 2015). Although it might seem that depression is inevitable for the terminally ill, "patients with advanced and chronic disease are as likely to benefit from antidepressant therapy and supporting psychotherapy and counseling as other populations" (Meier, McCormick, & Arnold 2015). Making psychological sense of terminal illness or how to live in a manageable way with a chronic illness is essential for both groups of patients.

Although there are certain similarities in the treatment of both the terminally ill and the non-terminally ill, it is also important to remember certain differences. In patients still undergoing active treatment for their illnesses, coordination of care is imperative. "Seriously ill patients and their families face major challenges in navigating and understanding their care plan(s) within a complex and fragmented medical system requiring negotiation between multiple settings, specialists, and diagnostic and treatment interventions" (Meier, McCormick, & Arnold 2015). In some instances, certain palliative treatments may need to be 'dialed down' for patients to fully benefit from intensive therapies; for patients who experience severe side effects from their treatments, a more intensive palliative care plan may be required. Palliative care may also need to be adapted to the needs of non-terminal (and in some cases terminal patients) that are still active in the world, given their occupational and personal needs. Patients and providers must consult with one another to balance the patient's need for pain relief with the need to remain alert and coherent during acts of daily life. Memory and other functions may be inhibited by palliative treatments.

Venues of treatment may also vary depending on the needs of the patient. For most non-terminal patients, the primary venue is ambulatory, or in-home treatment supplemented with visits from nurses or visits to a healthcare provider. For terminally ill patients, in-patient care is often preferred, given the need for professional monitoring of symptoms on a regular basis. Inpatient care is most frequently used for patients with "difficult-to-control symptoms; medical needs that cannot be optimally managed in another setting; distressed families in need of a higher level of support; [who have a] need for transfer out of a critical care setting; [and] patients who are imminently dying" (Meier, McCormick, & Arnold 2015). Hospice care often includes palliative care for the terminally ill, but it is important to remember that hospice is not synonymous with palliative approaches, it is merely one type of many.

For both the terminally and non-terminally ill, achieving a sense of control over the process is essential. For the terminally ill, there may be a need to allocate care at some point to a caregiver, but for as long as possible, medical ethics demands that the patient have guidance over his or her own care. In the case of the chronically ill, one of the most frustrating aspects of sickness is to lose such empowerment over one's own health and providing a modality of treatment which allows this is essential. Empowerment may include taking an active role in choosing medications in consultation with a healthcare provider or deciding when and what types of curative and palliative treatments to use.

One problem which can complicate treatment, however, is the demand from insurance providers to create black-and-white divides between curative and palliative care, even though for many extremely ill patients that still have some hope this can be difficult to define. "An open access hospice provides treatments that palliate symptoms and enhance the quality of life, even if the treatments are considered to be disease directed" but "Medicare may consider the treatment too aggressive or 'not hospice appropriate' and disallow coverage" for treatments such as chemotherapy, radiation therapy, and transfusions ("The debate in hospice care," 2008). "In another study, data on more than 9,000 discharged hospice patients indicated that only 14% of hospices provided care across five key categories of palliative care (nursing care, physician care, medication management, psychosocial care, and caregiver support)" ("The debate in hospice care," 2008).