Palliative care, a medical specialty officially recognized in the US since 2006, centers on enhancing comfort and has roots stretching back centuries within the hospice movement. Today, a significant majority—80 percent—of hospitals with 300 beds or more provide access to palliative care specialists or dedicated teams. These professionals collaborate with a patient’s primary physicians to alleviate the multifaceted distress—physical, social, and spiritual—associated with serious illnesses, their treatments, and healthcare decisions.
Decoding Palliative Care in Hospitals
Palliative care is fundamentally about providing relief from the distressing symptoms caused by illness or injury. Unlike curative care, which aims to eradicate disease, palliative care prioritizes patient comfort. The essence of palliative care lies in mitigating the severity and unpleasantness of disease symptoms without necessarily eliminating the underlying cause. It’s about lessening suffering and enhancing overall quality of life, especially within the hospital environment.
Palliative Care vs. Hospice Care: Clarifying the Distinction in Hospital Settings
It’s crucial to differentiate between palliative care and hospice care, especially when considering hospital programs. While both focus on symptom management, hospice care is specifically designed for individuals in the final stages of life, typically within the last six months as determined by a physician. Hospice care is pursued when curative treatments are no longer the primary focus, whereas Hospital Palliative Care Programs are available at any stage of illness, from initial diagnosis onward, and can be provided alongside curative treatments.
Palliative medicine within hospitals often addresses serious conditions like chronic respiratory diseases, kidney disease, heart failure, HIV/AIDS, progressive neurological conditions, and cancer. A key aspect of hospital palliative care programs is facilitating “Goals of Care Discussions.” These conversations are intended to equip patients and their families with the necessary information to define their healthcare objectives and desired outcomes.
Core Goals of Hospital Palliative Care Programs
Hospital palliative care programs are structured around several key objectives:
- Aligning Treatment with Patient Values: Ensuring that medical treatments are consistent with a patient’s personal values, preferences, and life goals.
- Enhancing Quality of Life: Improving the overall well-being and quality of life for both the patient and their family throughout the course of a serious illness.
- Minimizing Suffering: Actively working to reduce pain, discomfort, and other distressing physical symptoms.
- Addressing Emotional and Spiritual Needs: Providing support to alleviate emotional distress, anxiety, depression, and offering spiritual counseling as needed.
- Practical Support: Assisting with safety, mobility issues, and necessary medical equipment to improve daily living within the hospital or upon discharge.
- Empowering Decision-Making: Supporting patients and their caregivers in making informed decisions about their healthcare journey.
The Interdisciplinary Hospital Palliative Care Team
Hospital palliative care is delivered by a specialized interdisciplinary team, mirroring the structure of hospice teams. This team typically includes:
- Physicians and Nurse Practitioners: Providing medical evaluations, developing care plans, and managing complex symptoms.
- Registered Nurses (RNs): Offering direct patient care, symptom monitoring, and patient education.
- Social Workers: Assisting with emotional support, resource navigation, and addressing psychosocial needs.
- Chaplains: Providing spiritual and religious support tailored to the patient’s beliefs and background.
Broad Benefits of Hospital Palliative Care Programs
Hospital palliative care programs offer wide-ranging benefits to patients and their families. Physically, these programs effectively manage symptoms such as pain, fatigue, appetite loss, nausea, vomiting, and sleep disturbances through medication, nutritional guidance, relaxation techniques, and complementary therapies.
Beyond physical relief, hospital palliative care addresses the emotional and psychological burdens of serious illness. Counseling, support groups, and family meetings are utilized to help patients and families cope with depression, anxiety, and fear, fostering emotional resilience and improved communication.
What Services Are Included in Hospital Palliative Care?
Hospital palliative care begins with a comprehensive assessment to understand the patient’s specific symptoms, needs, and current medications. A key aspect can be the adjustment of medications to minimize uncomfortable side effects.
Beyond medication, hospital palliative care programs incorporate non-pharmacological approaches like specialized nutrition plans and breathing exercises to manage symptoms. Complementary therapies may also be integrated to provide additional relief and address specific patient needs.
Hospital palliative care is highly personalized, adapting treatments to each patient’s unique needs and tolerance for discomfort. Regular communication between the palliative care team and the patient ensures that symptom management is responsive and effective. For patients unable to communicate directly, the team uses established pain assessment tools and clinical expertise to provide appropriate symptom relief.
Duration of Hospital Palliative Care
Hospital palliative care programs are flexible and can be initiated at any point during an illness, for any duration, and alongside curative treatments. This contrasts with hospice care, which, while including palliative care principles, is limited to the last six months of life.
Research indicates that early integration of palliative care in hospitals leads to increased patient and family satisfaction, better pain management, and even improved survival rates in some conditions. Importantly, if a patient in hospice care decides to discontinue hospice services, they can still continue to receive palliative care support within the hospital setting.
Initiating a Conversation about Hospital Palliative Care
For patients and families facing the complexities of serious illness, hospital palliative care teams offer support beyond medical symptoms. They can assist with navigating financial, legal, employment, transportation, and housing concerns. Furthermore, hospital palliative care addresses spiritual questions and needs, respecting diverse cultural and religious backgrounds.
Hospital palliative care clinicians are trained to prioritize listening to patients and families, understanding their needs, goals, concerns, and questions. They value patient experiences of pain and discomfort and skillfully guide conversations to uncover underlying issues, ensuring a comprehensive and patient-centered care plan within the hospital environment.
The effectiveness of palliative care in enhancing quality of life is well-documented. Effective symptom management and a supportive listening environment contribute to patients feeling better and living more fully, even while hospitalized. Hospital palliative care consultations can also contribute to lower healthcare costs by potentially reducing hospital readmissions and avoiding treatments that are not aligned with the patient’s goals.
VITAS Approach to Hospital Palliative Care Programs
VITAS Healthcare exemplifies a comprehensive approach to hospital palliative care programs. Their model centers on a personalized care plan developed by an interdisciplinary team to meet each patient’s unique needs within the hospital setting. This team supports patients from initial diagnosis through the challenges of curative therapies and their after-effects. VITAS teams include professionals board-certified in hospice and palliative medicine, alongside chaplains and social workers, ensuring holistic care.
A VITAS palliative care consultation provides timely and specific information, helping patients and families understand the benefits of hospital palliative care. This consultation also assists hospital physicians and the broader care team in delivering the most appropriate and effective care.
In situations where a patient’s symptoms escalate beyond routine management, VITAS offers 24/7 support to transition patients to a higher level of care within the hospital, including crisis nurses for immediate symptom control. For acute symptom exacerbations, VITAS facilitates transfer to an inpatient hospice unit within the hospital for intensive symptom management until the patient can return to a more stable care setting.
