When Should Someone Be Offered Palliative Care?

Many people think palliative care refers to end-of-life care. While end-of-life care—also known as hospice care—is a type of palliative care, not all palliative-care patients have terminal illnesses. In fact, palliative care is appropriate at any stage of illness in the case of serious, life-altering conditions. The goal is to manage mental and physical symptoms, which can apply to patients at any time.¹

So, when should someone be offered palliative care? 

This type of care becomes appropriate for patients with life-threatening or life-limiting illnesses who need intensive intervention to control symptoms and regain or maintain an acceptable quality of life. Palliative care is typically concurrent with curative treatment. Naturally, the exact timeline differs quite drastically from one patient to another, affected by a number of factors.

What is Palliative Care?

Palliative care helps patients live comfortably, as their quality of life is threatened by a serious illness. This is done through an interdisciplinary approach to managing symptoms and side effects, whether from the condition itself or various intensive treatments, such as chemotherapy for cancer patients. 

Performed in tandem with curative, therapeutic treatments, palliative care addresses not only the physical needs, but the emotional, mental, spiritual, and financial needs of the patient and their loved ones. Providers come from different medical or support backgrounds and work together to provide symptom relief, spiritual guidance, counseling, financial assistance, and more. 

There are many types of care that can insure a patient lives comfortably with their condition. For more information, read our blog post addressing the difference between palliative care and hospice. 

When is Palliative Care Appropriate?

Palliative care can be used to manage and control the symptoms and side effects of many conditions, but there are numerous factors to consider when deciding if it’s appropriate for a patient or not.

The two primary considerations are the:²

• Patient’s condition – Palliative care is useful in managing debilitating symptoms from the condition itself or its treatment. Patients should discuss the symptom progression they can expect, their treatment options, and the side effects from those treatments to make an informed decision about the value of palliative care. Even if their condition isn’t immediately life-threatening or life-limiting, palliative care can help patients manage harsh side effects and continue with daily activities. For example, Palliative care might be approrpiate for someone learning how to recover from a stroke.
• Patient’s expectations – Once a patient understands both their prognosis and potential treatment options, they may decide to forgo treatment due to its unmanageable side effects. Or, they may choose to pair intensive therapies with palliative care to better manage the additional side effects. In both cases, palliative care may be the right choice by mitigating symptoms and ensuring as much comfort and happiness as possible.

What Diseases Can Be Treated with Palliative Care?

Though palliative care was created for terminal patients, it has evolved as a medical specialty that seeks to address an individual’s needs and provide holistic support for patients and families. 

It can be used to treat discomfort and pain in two major categories:

• Symptoms of serious illnesses – Multiple sclerosis, Alzheimer’s, AIDS, amyotrophic lateral sclerosis, lung disease, heart disease, and cancer all may be eligible for palliative care, as these diseases often have uncomfortable or painful symptoms.
• Side effects of harsh treatments – Many of these serious conditions involve equally intensive treatments, such as chemotherapy or opioid pain medication, which bring about unpleasant side effects. Some patients undergo palliative care to treat the side effects rather than the underlying illness.

There are palliative care options that address symptoms and side effects across multiple categories, including:

• Physical – Pain, weakness, and loss of motor control or sensation are some of the most common physical symptoms of serious conditions and one of the biggest opportunities for effective palliative care interventions.
• Digestive – Often as a result of strong medications, patients can experience nausea, vomiting, constipation, diarrhea, bowel and bladder dysfunction, and loss of appetite. Many of these side effects can be mitigated through appropriate care.
• Pulmonary – Breathing difficulties and chronic coughing are regularly seen in patients with chronic obstructive pulmonary disease, pulmonary fibrosis, and other respiratory illnesses. Inhaled or oxygen therapy can reduce these difficulties.
• Mental – Patients with chronic or life-limiting conditions often face mental and cognitive difficulties such as depression, confusion, and insomnia. Palliative care addresses mental as well as physical health, helping patients achieve more restful sleep and a better outlook on life through therapy, counseling, or spiritual practices.

Who is Eligible for Palliative Care?

Palliative care is available for patients with a serious illness, no matter the stage. While cancer patients are perhaps the most notable and common group to receive palliative care, it’s also available to patients with chronic or progressive life-limiting illnesses like multiple sclerosis and amyotrophic lateral sclerosis, for example.

In most cases, patients are eligible for palliative care if they:

• Have been diagnosed with a serious, life-threatening or life-limiting condition
• Are continuing to seek out and undergo curative treatments
• Experience significant pain or other symptoms that they find unmanageable or difficult to manage
• Need help coping with the emotional and psychological effects of having a life-altering condition

When Can Patients Begin Palliative Care?

Patients can seek out palliative care on the day of their diagnosis or years down the line once their symptoms reach a debilitating threshold—the journey toward care is different for everyone. 

Because of the interdisciplinary and symptom-mitigating approach of palliative care, earlier is usually better, especially for patients with chronic or progressive conditions, as they’re usually able to better manage the subsequent stages of their illness.³ With certain serious diagnoses, patients may experience depression, fatigue, anxiety, and pain from the very beginning, and would benefit from immediate and proactive palliative care.

Debunking Myths About Palliative Care and When to Start

Palliative care is often used as a catchall term for hospice, comfort, or end-of-life care. In reality, palliative care is a broad scope of care that includes hospice and end-of-life care as well as early and mid-stage care for serious conditions of all kinds.

If you’re considering palliative care for yourself or a loved one, you’ll want to ignore these common misconceptions about when and why you might start this type of treatment:

• “Palliative care is hospice care” – Hospice care is a type of palliative care, as a patient progresses to the final stages of life and forgoes curative treatment, but the two are not the same thing. Palliative care can be used to manage the symptoms and side effects of chronic, debilitating illnesses in tandem with curative care. Many patients recover or live long, healthy lives without progressing to hospice care. 
• “Palliative care is for terminal patients” – Patients may be eligible for palliative care at any point in their illness, including after receiving a highly optimistic diagnosis. Progressive illnesses can move quickly, so some patients are given palliative care early on to slow the progression and maintain their quality of life, while others choose palliative care while receiving intensive treatment that eventually cures their disease.
• “Choosing palliative care means giving up on a cure” – On the contrary, palliative care involves many doctors and specialists who deliver curative treatments alongside soothing therapies. Palliative care allows patients to manage their symptoms more effectively and achieve a greater quality of life while seeking a cure or trying life-prolonging therapies. 
• “Palliative care is just for the patient” – Palliative care is intended to support the patient in all aspects of their life, which includes supporting their family, friends, and caregivers. The patient’s support system is included in the approach to care and often receives guidance in coping with the financial, emotional, and logistical aspects of a loved one’s illness.

How to Start Receiving Palliative Care

Once you’ve determined that it’s the right time to start palliative care, you can begin identifying the course of action that will best benefit you or your loved one:

• Identify the right palliative care option – In-home care is incredibly common among palliative care patients, though you also have options like inpatient and residence visits. Depending on the progression of your condition, you may need a full-time private duty nurse or someone to drop in occasionally and help with basic care and tasks.
• Seek out a provider – Your primary doctor or specialist will likely have palliative care recommendations, but it’s important to conduct your own research to determine a solution that meets your personal, financial, and medical needs. Some providers only offer inpatient or in-person services, while others grant you the freedom to stay home while receiving the same quality of care.
• Determine insurance coverage – Palliative care is usually covered, at least in part, by most private insurance companies and certain Medicare programs. However, you’ll likely still pay some out-of-pocket expenses, depending on the type of care you’ll be receiving. Private insurance plans often cover a wider range of services than Medicare.
• Create a personalized care plan – Your palliative care team will be able to craft a specialized treatment plan and schedule that directly addresses your most pressing needs, whether that’s medication management, physical therapy, counseling, at-home assistance, or anything else you need.

Is Hospice Care the Same as Palliative Care?

Though many people use the terms interchangeably, hospice care and palliative care are not the same. Hospice care falls under the broad umbrella of palliative care but is available only to patients nearing the final stages of life.⁴ 

When a patient with a terminal or life-limiting illness chooses to end curative treatment and has a life expectancy of six months or less, they’re eligible for hospice care. Much like palliative care, this treatment plan can give patients guidance, support, comfort, pain relief, and dignity at the end of their life. 

Receive Palliative Care from Alliance Homecare

If you’re at a stage in your life where you or a loved one could benefit from palliative care, there’s no better time to start than right now. By mitigating the symptoms and progression of a chronic, progressive, or terminal illness, you can enjoy the quality of life you deserve again.

If you’re considering palliative care services or in home nurse care, the dedicated team of medical professionals at Alliance HomeCare can provide support through in-home health care, private duty nurses, home health aides, and end-of-life care. Contact us to learn more about our palliative care services.

Sources: 

1. WebMD. When Is Palliative Care Appropriate? https://www.webmd.com/palliative-care/when-is-palliative-care-appropriate 
2. Hackensack Meridian Health. When Should Someone Be Offered Palliative Care? https://www.hackensackmeridianhealth.org/HealthU/2021/10/14/when-should-someone-be-offered-palliative-care/ 
3. Center to Advance Palliative Care. About Palliative Care. https://www.capc.org/about/palliative-care/ 
4. National Institute on Aging. What are Palliative Care and Hospice Care? https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care