This is the second in a series of articles about palliative care.
Palliative (PAL-yuh-tiv) care focuses on reducing pain and suffering and increasing quality of life in people with serious illnesses, regardless of the expected course of their disease or how long they are expected to live. It can also help their families.
For a one-page overview called "Palliative Care: What You Should Know," go to http://www.getpalliativecare.org. Click on "What Is It?" and then on "Handout for Patients and Families." Palliative care is explained for doctors at http://www.caringinfo.org/files/public/brochures/NHPCO_Professional_flie....
To get one perspective on whether palliative care might be helpful for you or someone you care about, go to www.getpalliativecare.org. Click on "Is It Right for You?" and take the quiz.
But what exactly does palliative care consist of? Effective treatments address symptoms such as pain, nausea, insomnia, digestive complaints, persistent exhaustion, loss of appetite, trouble breathing, depression and anxiety. Treatments cover the spectrum and may include services such as massage therapy, physical therapy, speech therapy, occupational therapy, hot packs, cool packs, exercise, talk therapy and/or sessions with a chaplain or other spiritual advisor. Drugs, natural treatments and supplements may include corticosteroids to improve appetite and reduce pain, herbal tea, melatonin or medicines to improve sleep, ginger or medicines to reduce nausea, and so forth.
Practitioners may refer patients to complementary and alternative care providers to get chiropractic treatment, acupuncture and other treatments. Ideally, a palliative care provider will arrange for an interdisciplinary approach to care, involving a variety of providers whose care is coordinated to get the best results for the patient.
A palliative care provider may review the list of medications an individual is taking; side effects and drug interactions are common, and sometimes in consultation with the prescribing doctors, the use of some drugs can be reduced or eliminated.
Dr. Sam Downing, Medical Director at Good Samaritan's Prescott Home Health and Hospice and also its Prescott Valley skilled nursing facility, and Board-certified in Hospice and Palliative Medicine, noted that the first step in putting together a comprehensive palliative care plan is to understand the individual's goals and values. He observed, "Often, the patient doesn't know why we're asking about their goals. Their view is, 'You're the doctor; you tell me what I need to do.'"
But the palliative care provider wants to hear from patients what their priorities are. What activities do they wish they could take part in that their symptoms have prevented them from doing? With this information, an individualized plan of care can be developed to address their most troubling symptoms and often restore their ability to function in ways that significantly improve their quality of life.
In addition, palliative care providers can help patients understand what to expect as their condition progresses, and figure out what care will be consistent with their values and preferences when they have complex illnesses and potential treatments have both benefits and downsides.
Dr. Kevin Doyle, Medical Director for Granite Mountain Home Care and Hospice, and Board-certified in Hospice and Palliative Medicine, explained how palliative care can help with these tricky decisions.
"A large portion of what I do is demystify what's going on. When patients are in the hospital, maybe the neurologist comes in, the cardiologist comes in and all the specialists understandably look at their own pieces of the pie. We have somewhat lost in recent years the comprehensive look that used to be provided by the family physician. The care for most patients in the hospital today is overseen by hospitalists (doctors based in the hospital). Primary care doctors typically no longer perform this role. And neither the specialists nor the hospitalists have the time to do a comprehensive evaluation of the patient's entire situation, including emotional, spiritual and psychological issues that may surface because of their medical conditions. But this is what palliative care practitioners do."
They can help patients understand all of their options, from getting the most aggressive treatment possible to discontinuing traditional medical treatment - and what would be likely to happen to them as a result of choosing each of those options.
Next week's column will explain how to figure out what you want from palliative care.
