Palliative Care: What Is It and How Is It Different from Hospice?
Hospice care is palliative care, but palliative care is not hospice. The difference between these two types of care is something that I have found difficult to clarify myself let alone explain to others. However, this care is a fundamental part of treating any chronic or terminal illness.
With that in mind, I contacted Kimberly Angelia Curseen, M.D., Associate Professor of Internal Medicine at Emory School of Medicine and Director of Outpatient Supportive/Palliative Care Clinic Emory Healthcare. Dr. Curseen has a passion for palliative care and was happy to clarify this important type of medical care that seems to pass under the radar.
AgingCare: Dr. Curseen, let’s start with the basics. What is palliative care?
Dr. Curseen: According to the Merriam-Webster dictionary, the word palliate means “to make the effects of (something, such as an illness) less painful, harmful, or harsh.” It originates from the Latin word pallium, meaning to cloak.
Palliative care, also known as supportive care, is focused on providing relief from the symptoms and stress of a serious illness—whatever the diagnosis may be. The goal is to improve quality of life for both the patient and their family. This care can help with emotional and spiritual problems as well as physical problems.
AgingCare: It seems like the difference between hospice and palliative care is the diagnosis. Are there any other ways this differs from hospice?
Dr. Curseen: While hospice care is typically provided to patients throughout the end of their lives, palliative care is appropriate at any age and at any stage in a serious illness. This type of care can also be provided in conjunction with curative treatment. Palliation can be provided at first diagnosis or late into the disease process because access is based on the needs of the individual.
This care is delivered by an interdisciplinary team of medical professionals. The team works closely with the patient’s specialist to help develop an individualized symptom management plan to help them accomplish their treatment goals.
Hospice is the medical service that provides specialized palliative care to individuals who are approaching the end of their lives. In these individuals the doctors involved have concluded that this person may have a life expectancy of less than 6 months if their illness follows its natural course.
AgingCare: Is there any scientific evidence showing that this care makes a significant difference in a patient’s health?
Dr. Curseen: Although palliative and hospice care can be beneficial to patients with countless chronic illnesses, both are probably best known for working with patients who have been diagnosed with cancer. According to the American Cancer Society, “Studies have shown that patients who had hospital-based palliative care visits spent less time in intensive care units and were less likely to be re-admitted to the hospital after they went home. Studies have also shown that people with chronic illnesses like cancer who get palliative care have less severe symptoms.”
Several recent studies have shown that palliative care improved patient quality of life in addition to reduction in time patients have to spend in acute care. One study in the New England Journal of Medicine showed that patients with non-small cell lung cancer (SCLC) who had outpatient palliative care not only have improved quality of life, but also lived longer than patients who did not receive this care intervention.
It is important to remember, though, that these benefits are not limited to patients with cancer. Patients with illnesses such as dementia, Parkinson’s, heart failure, ALS and lung disease have experienced benefits like symptom reduction and lower hospitalization rates as well.
AgingCare: How does palliative care help someone with a serious illness?
Dr. Curseen: For persons with a serious illness such as cancer, having a supportive care team provides individuals with access to expertise in symptom management. Whether the goal is to cure, slow, or simply manage the disease, the journey of a cancer patient can often be fraught with distressing symptoms of pain, shortness of breath, difficulty sleeping, nausea, anxiety and fatigue. Early, aggressive management of these symptoms becomes an essential part of patient care in order to maintain quality of life throughout the course of the disease.
AgingCare: Who provides this care and where is it given?
Dr. Curseen: Palliative care is provided by a team of doctors, registered nurses and other specialists who work together with a patient’s primary doctor. Palliative care teams can provide this care in the hospital, through clinics, and, in some programs, in the home. Other professionals like massage therapists, dieticians, pharmacists and chaplains may be added to a patient’s care team. The purpose of this diverse group of experts is to help the patient and their family members understand the disease as well as all available treatment options, and facilitate communication and collaboration amongst the patient’s health care providers.
AgingCare: Does insurance cover the costs of palliative care services?
Dr. Curseen: As with other hospital and medical services, Medicare, Medicaid and most private insurance plans will cover all or part of these care services. The extent of your coverage depends on your needs and your insurance plan. A prior authorization maybe required before your visit. Be sure to check with your insurance company for help with specific questions related to payment options. A social worker may be able to help you with the financial aspects of this care as well.
It is important to spread the message that this type of care is available since there are many people who are struggling with pain and other symptoms who are not aware that their life can be improved while they are undergoing treatment.
How do you know if this care is right for you or your loved one? If you have a serious illness and the symptoms are interfering with your day-to-day life, ask your primary care doctor about palliative options. For many people, improving even one serious symptom, such as severe nausea, can make a vast difference in their overall quality of life. It can't hurt to consult with a health care provider about available options.