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.
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.”
Kimberly Angelia Curseen, M.D., a palliative care physician affiliated with the Emory University Healthcare System, says that palliative 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,” Dr. Curseen explains.
While palliative care, also known as supportive care, may seem straightforward, it is not widely known or understood, particularly due to its relationship with hospice care. Below, Dr. Curseen helps differentiate these two modes of care and how patients and families can benefit from them.
Hospice vs. Palliative Care
While hospice care is typically provided to patients at the end of life, palliative care is appropriate at any age and at any stage in a serious illness. Palliative 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,” says Dr. Curseen.
Palliative care is delivered by an interdisciplinary team of medical professionals that works closely with a patient’s specialist to develop an individualized symptom management plan and help accomplish treatment goals.
Hospice is the medical service that provides a specialized type of palliative care to individuals who have received a terminal diagnosis and are approaching the end of life. When doctors involved have concluded that a person likely has a life expectancy of less than 6 months if their illness follows its natural course, then they are considered a candidate for hospice care.
It is also worth noting that hospice and palliative care are often further confused because many organizations provide both types of care. While they may be similar, this does not change the fact that each care program involves very different eligibility requirements for acceptance.
The Benefits of Palliative Care
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 and reduced the amount of time patients spend in acute care. Dr. Curseen cites one study published in the New England Journal of Medicine which shows that patients with non-small cell lung cancer (NSCLC) who had outpatient palliative care not only had an improved quality of life, but also lived longer than patients who did not receive this care intervention.
However, Dr. Curseen urges the public to remember that these benefits are not limited to patients with cancer. “Those with illnesses, such as dementia, Parkinson’s disease, chronic obstructive pulmonary disease (COPD), heart failure and ALS, have experienced benefits like symptom reduction and lower hospitalization rates as well,” she notes.
How Palliative Care Works
For persons with one or more chronic illnesses, having a supportive care team provides access to expertise in symptom management. For example, cancer patients ideally receive aggressive treatments early on, targeting affected areas of the body. But, with this treatment comes a barrage of distressing symptoms, such as pain, shortness of breath, difficulty sleeping, nausea, anxiety and fatigue. “Whether the goal is to cure, slow or simply manage the disease, equally early and aggressive management of the symptoms that arise becomes an essential part of treating the whole patient and maintaining their quality of life,” Dr. Curseen advises.
Palliative care teams are composed of doctors, registered nurses and other specialists who work together with a patient’s primary doctor. These teams can provide care in the hospital, at clinics, and, in some programs, through home visits. Other professionals like massage therapists, dieticians, pharmacists and chaplains may be added to a patient’s care team as well. “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 all the patient’s health care providers,” explains Dr. Curseen.
Is Palliative Care Covered by Insurance?
As with other hospital and medical services, Medicare, Medicaid and most private insurance plans will cover all or part of palliative care services. The extent of coverage depends on an individual’s unique needs and their current insurance plan. “A prior authorization may be required before an initial visit,” Dr. Curseen acknowledges, “so be sure to check with the insurance company for help with specific questions related to payment options. A social worker may be able to help find solutions regarding the financial aspects of this care as well.”
Spreading Awareness of Palliative Care
“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 but unaware that their life can be improved while they are undergoing treatment,” Dr. Curseen urges.
If you or a loved one has a serious illness and the symptoms are interfering with day-to-day life, talk to a 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 all available options.