Introduction to Palliative Care Dr. Sandhya Bhalla-Regev, MD

Palliative care is the right of every individual suffering from incurable illness.

Position

Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people with serious illnesses. It focuses on providing patients with relief from the symptoms, pain, and stress of a serious illness—whatever the diagnosis.

The goal is to improve quality of life for both the patient and the family.

What is Palliative Care?

Difference between Palliative care and Hospice programs

Curative care is directed at healing or curing a disease....like taking an antibiotic for a bladder infection, Vitamin C if you have scurvy or receiving therapy following a stroke.

Palliative care involves offering care that helps relieve the symptoms, but does not cure or treat the cause of a disease...like getting a massage for a stiff neck and sore shoulder which is caused by a ruptured disc in the cervical spine. The massage helps alleviate some of the pain, but does not cure the spinal defect.

Care Defined

Treatments and interventions that enhance comfort and improve quality of life.

No specific therapy is excluded from consideration.

Palliative Treatments

From a patient perspective:

Why Palliative Care?

Palliative Care in the Elderly

Mr. H is an 80 year old male with advanced Parkinson’s disease

He was a neuroscientist until retiring 10 years ago.

Diagnosed with Parkinson’s Disease 10 years ago He can no longer walk, is wheel chair to bed

bound, cannot make his needs known He is dependent on caregivers for feeding,

toileting, dressing, walking and transfers. He has been married for 55 years. He has two children who live in other states His wife is his sole caregiver and distraught over

his decline and feels very guilty about making decisions for her husband.

Mr. H’s Story

Mr. H has been hospitalized many times for UTI and pneumonia

Mr. H has been losing weight. Mr. H gets agitated when doing personal

care. Mr. H has just moved to and RCFE due to

continued decline He Suffered from pain from contractures

in his legs and arms

Mr. H’s Story Continued

Palliative Care Consult requested to discuss goals of care with Mrs. H and children.

His wife confirmed that what gave meaning to Mr. H’s life was his intellect and his family

She felt that he would not have wanted to continue getting aggressive treatments

Started on methadone for pain management Mr. H went onto hospice care and a month later went

into respiratory distress from aspiration and died of pneumonia

His family members were much more prepared after going through discussions with the palliative care team

1. Address pain and other uncomfortable symptoms.

2. Assist patients with difficult decision making.

3.Coordinate care with other providers to help patients navigate the health system.

4. Guide patients to make a plan for living well based on their needs, concerns and goals.

5. Address code status/POLST.6.Provide advanced illness prognostication.

Palliative care consult

Relief from symptoms, such as; Pain Shortness of breath Fatigue Constipation/Diarrhea Nausea/Vomiting Loss of appetite Difficulty sleeping

Expected Benefits of Palliative Care

Palliative care is provided by a team of doctors, nurses, social workers and other specialists who work together with a patient’s other doctor(s) to provide an extra layer of support.

The care team may also include, clergy, massage therapists, pharmacists, nutritionists and others as needed per specific patient needs.

Who Provides Palliative Care?

The palliative care team works in partnership with you own doctor(s) to provide an extra layer of support for you and patient and family.

The team works together to provide additional support for communication, navigation of the health system and symptom management.

What About my Doctor?

Palliative Care is provided in a variety of settings.

Hospitals Outpatient clinics Home Hospice Long term care facilities (skilled nursing

homes)

Where can I receive palliative care?

1. Presence of a serious illness :Canceradvanced COPDCVAESRDAdvanced Heart DiseaseLiver DiseaseALSHIVAlzheimer’s Dementia

Criteria for Palliative Care Consult

Declining ability to complete ADLs Weight loss or considering tube feeding Metastatic cancer despite treatments Two or more hospitalizations in 3 months Difficult to control physical or emotional

symptoms Patient, family uncertainty regarding

treatment Family distress impairing decision

making

2. And one or more of the following…

Most insurance plans, including Medicare and Medical, cover palliative care.

If cost is a concern, a social worker or financial consultant from the palliative care team can assist in determining your options.

Who Pays for Palliative Care?

Ask for it!

Tell your doctors, nurses, family and caregivers that you want palliative care.

How Do I Get Palliative Care?

Get Palliative Care.Org

Resources

To cure sometimes, to relieve often, to comfort always

Questions???