Doctors explain hospice and palliative care
By Jennifer Kett, MD, MA, and David Brunelle, MD
November is National Hospice and Palliative Care Month. Like many people, you may be wondering what the terms hospice care and palliative care really mean.
Palliative care is a unique philosophy of medical care aimed at optimizing a patient’s quality of life. Palliative care providers accomplish this by addressing a patient’s physical symptoms in the context of the intellectual, social, emotional and spiritual challenges that commonly arise when a person experiences serious illness.
A major goal of palliative care is to guide patients through the process of figuring out what is most important to them as unique individuals. By doing this, we make sure the medical care they receive is consistent with their values.
Palliative care is appropriate at any stage of a life-limiting illness. Providers on our team can be helpful at the time of initial diagnosis, as patients and their families gather complex scientific information, weigh their treatment options, and begin to cope with the emotional shock and spiritual crises that typically arise. Palliative care providers are also helpful during the course of a serious illness, as patients need assistance with pain and symptom management. Currently, adult palliative care consultation is only available for inpatients.
Ancillary to this, we also provide ongoing support to those coping with progressive social, emotional and spiritual concerns. Palliative care providers work as a team to help ensure a patient’s care is well-coordinated and that they understand all of the information necessary to make informed, tailored medical decisions.
Over time we build relationships that facilitate a patient’s need to plan for their future.
Some patients — and providers — worry that involving palliative care means they can no longer seek a cure. This is simply not true. We can be helpful to patients who are actively seeking curative treatment. We ask patients and their families to guide these conversations.
Our job is to support and guide patients through crucial conversations with the express purpose of identifying the goals of care they choose and then communicating those clearly to the larger care team. Over time those goals can and will change for many in our service, but that process happens organically and as directed by them.
Hospice care is a specialized form of palliative care that is primarily aimed at patients in the terminal stage of illness or clearly approaching the end of life. Hospice care is typically focused on caring for patients whose primary goal is comfort care rather than curative interventions.
Hospice care providers focus on optimizing a patient’s quality of life as well as ensuring their comfort and dignity throughout the dying process. And while many who receive palliative care may one day transition into hospice care, many will not.
It is a common worry that choosing hospice care means that individuals and families are “giving up.” It is true that patients who receive hospice care are no longer actively receiving curative treatment, but delivery of these services involves anticipating and intensively managing a patient’s pain and symptoms along with their emotional and spiritual concerns. This is an ongoing, active process that may involve providing medications, equipment, counseling, spiritual reflection, legacy building and other forms of support.
Hospice care can often be provided in a patient’s home and is generally covered by Medicare, Medicaid and most private insurance companies. A recent research study by the National Hospice and Palliative Care Organization (NHPCO) found that 96% of people who had experienced hospice care through friends or family members had a positive impression of the care that was provided.
You can find out more about hospice and palliative care at Moments of Life: Made Possible by Hospice, or by talking to your doctor. MultiCare offers skilled palliative care in the inpatient setting and hospice care services for adults, as well as inpatient and community-based complex/palliative care and hospice for children.
Dr. Jennifer Kett is a specialist in pediatric palliative care and pediatric ethics at Mary Bridge Children's Hospital. She completed her training at the University of Washington and Seattle Children’s Hospital. She has written several articles for medical journals about complex medical decision making for children.
Dr. David Brunelle is the Medical Director for the Pediatric Complex Care Support Team at Mary Bridge Children’s Hospital. He is a graduate of Dartmouth College and the University of Vermont College of Medicine and completed his Residency in General Pediatrics at the University of Washington. Dr. Brunelle has been in private practice in Seattle and was a proud member of the Inpatient Pediatric Service before specializing in the care of medically complex children.
This story was originally published in November 2015 and updated in November 2016.