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Q: Is palliative care the same thing as hospice care?

A: Palliative care and hospice care are similar and over-lap BUT they are not synonymous.

Palliative care is a branch of medicine that treats patients and their families facing serious illnesses. It focuses on improving quality of life (QOL) through the prevention and alleviation of suffering. It works together along with curative treatments and focuses on relieving pain and other physical, spiritual, social, emotional problems. Palliative care is provided by a team of specialists including doctors, nurses, social workers, chaplains and others. It’s an extra layer of support during any stage of the disease.

Hospice care is supportive care given during the final phase of a terminal illness. To qualify for hospice in the United States, a patient is medically certified to have a life expectancy of six months or less.  Hospice care focuses of comfort care rather than cure. The goal is to support family members and to help the patient live fully until he/she dies. Hospice Care like palliative care is holistic and addresses alleviating not only physical symptoms (pain, shortness of breath, depression, etc.) but spiritual, social, emotional and financial problems as well. This comprehensive care is offered by an interdisciplinary team and includes bereavement care to family members after the death of their one.

Q: Why is pain management so important?

A: Pain affects a patient’s quality of life (QOL). When a patient is experiencing pain, he/she may not be able to sleep, eat, enjoy the company of family members and friends or function. The pain becomes the patient’s focus and robs the patient’s ability to enjoy his/her days fully.

Q: Will palliative/hospice doctors and nurses be able to get rid of all of my pain?

A: Unfortunately, the answer is “No.” The hospice team will be able to create a plan to help decrease your pain, help you function better and hopefully allow you to do the things that you want to do.

Q: Do I have to take morphine or another opioid to get rid of my pain?

A: Pain can be complex. Different types of pain require different types of medications. Some pain may be relieved with over-the-counter pain medications like acetaminophen or ibuprofen. More severe pain may require an opioid. Nerve pain, like diabetic neuropathy responds best to anti-seizure medications like gabapentin (Neurontin.) Most pain experts agree that the best pain management is a multi-modal approach. A multi-modal approach includes using multiple therapies to decrease the pain. This would include multiple drugs with different actions along with non-pharmacologic interventions (e.g. massage, physical therapy, heat/cold, distraction, cognitive behavioral therapy, etc.)

Q: When will I know it’s time for end-of-life (hospice) care?

A: It’s always a good idea to have on going conversations with your primary physician about your end-of-life goals and prognosis if you are living with a serious illness. Some possible signs to look for are: unintentional weight loss; increase symptoms like pain, nausea, fatigue; decreased alertness; increased hospitalizations, trips to the ER and doctor’s office; increased need for assistance with activities of daily living (eating, dressing, ambulating, toileting.) Also, ask questions regarding Benefit versus Burden of curative treatments. *A lot of people do not get the full benefit of palliative/hospice care because these important conversations are postponed until he last couple of days or weeks before a death. It’s better to have these conversations earlier instead of later.

Q: What’s one of the biggest misconceptions about Hospice care?

A: One big misconception is that Hospice means dying. Unfortunately, patients are often referred to hospice when they are actively dying. Thus, in some people’s minds, hospice = dying. The truth is Hospice is about LIVING fully with the time one has left. QOL improvements are facilitated when the hospice team has more time to address a patient’s and family’s needs (physical, social, spiritual, emotional, financial). * Remember, Hospice care is available up to patients 6 months (1/2 year) prior to an expected death.