Top 10 lists are not just for late night television anymore. Doctors at the Mayo Clinic in Rochester, Minnesota, developed their own list of things they wished everyone knew about palliative care.1 “Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative Care” is their unique way of observing November as Palliative Care Awareness Month.
Palliative care addresses the multifaceted aspects of care for patients facing a serious illness.
The goal is to improve quality of life (QOL) for patients at any point during their illness, regardless of their treatment plans. Accomplishing this requires an interdisciplinary team of professionals, including physicians, nurses, nurse practitioners, physician assistants, social workers, chaplains, and pharmacists.
Palliative care is appropriate at any stage of serious illness.
Palliative care is often mistakenly equated with end-of-life care, and patients too often resist accepting it during the diagnostic process. Disease modifying interventions may not be an option in late-stage disease. The palliative care focuses on improving QOL through symptom management and support for the patient and the patient’s family, which are tenets that can and should be applied at any point along the trajectory of a serious illness.
Early integration of palliative care is becoming the new standard of care for patients with advanced cancer.
Studies have shown that the older philosophy of introducing palliative care at the later stages of a disease is not as effective as early integration, preferably at the time of initial diagnosis. At this early stage, palliative care visits concentrate on symptom management and awareness of prognosis. In 2012, the American Society of Clinical Oncology (ASCO) recommended that palliative care should be integrated early in the illness for patients with metastatic cancer and/or a high symptom burden.2
Palliative care is not just for cancer. It is also beneficial for patients with other chronic diseases.
Palliative care can be beneficial to patients who bear a heavy symptom burden, such as those with severe chronic obstructive pulmonary disease (COPD), advanced heart failure (HF), pulmonary hypertension, end-stage renal disease, and such neurodegenerative diseases as amyotrophic lateral sclerosis (ALS) and Huntington disease. Critically ill patients in the intensive care unit are also good candidates for the benefits of palliative care.
Palliative care teams manage total pain.
The pain of cancer is well known; it affects 30% to 90% of cancer patients at some time during their illness. Pain is also associated with other serious illnesses. For example, patients with advanced COPD and those with severe HF often have significant pain, as do people with diseases such as ALS and end-stage renal disease. However, pain is still often undertreated. Many patients experience the physical, social, psychological, and spiritual suffering that defines total pain. These patients would benefit greatly from the multidisciplinary approach and expertise in pain management that palliative care clinicians provide.
Patients with a serious illness have many symptoms that palliative care teams can address.
A number of symptoms other than pain affect many patients with chronic and severe illness. Nausea, delirium, fatigue, dyspnea, and other distressing symptoms affect patients and their families. The palliative care team can help identify and address these troubling symptoms, as well as ameliorate their effect on caregivers.