Palliative Care to Improve Quality of Life

Some health care professionals may consider palliative care for those nearing end of life. This is because, in the past, the palliative care was focused on hospice care and meeting the needs of those nearing the end of life. Now it includes care for people at all stages of life-altering illnesses.

Your health care team may not use the term palliative care to describe these services. They might use terms like whole-person care, comfort-oriented care or supportive care.

Palliative care can be beneficial when:

• Seeking or receiving cancer treatment.
• Recently completed treatment (may or may not be cancer-free).
• Finished treatment years ago.
• Experiencing cancer as a chronic (ongoing) illness.
• Participating in clinical trials to evaluate treatments or quality of life issues.
• Have had cancers that are likely to recur.
• Have advanced cancer and may be approaching the end of life.

What is Palliative Care?

Palliative care focuses on preventing, treating, reducing or removing discomfort. It seeks to bring a patient personal satisfaction and improve quality of life. The National Consensus Project (NCP) for Quality Palliative Care has created a set of professional guidelines that define palliative care and provide guidance to health care professionals.

Palliative care includes services provided by a variety of health care and other professionals for physical, emotional, spiritual and practical concerns. These services may be delivered in and continued across various settings at different times. This is known as continuity of care. Palliative care can be provided in:

• Inpatient hospitals
• Outpatient clinics
• Physician offices
• Skilled nursing or assisted living facilities
• Health care provided at home

Palliative Care Professionals

For Physical Well-Being

• Primary Care Physician: supervises medical care
• Oncologist: designs treatment plans
• Palliative Medicine Specialist: prescribes medication
• Nurse Practitioner: may consult with or make referrals to specialists
• Social Worker: coordinates palliative care among all the different professionals; referrals to community and other resources; arranges family meetings.
• Pain Specialist (medical doctor): works with the primary care physician or oncologist to prescribe and monitor pain medications and other therapies.
• Other Medical Specialists: treat specific aftereffects (for example, fertility, cognitive or skin problems).
• Registered Nurse, preferably certified in hospice and palliative care: provides direct care; explains or answers questions about treatment; often helps coordinate care with other members of the team.
• Physical and/or Occupational Therapist: assists to regain strength or movement following treatment; provides assistance with activities of daily living such as dressing and bathing.
• Dietitian or Nutritionist: offers nutritional counseling and dietary plans to help choose appropriate foods and diet.
• Massage Therapist: provides therapeutic body work.
• Pharmacist: answers questions about and provides medications ordered by the physician.
• Complementary Therapy Providers: ask the health care team for recommendations about appropriate complementary therapies such as meditation, acupuncture or other therapies.

For Emotional, Social, Spiritual Well-Being

• Psychiatrist, Psychiatric Nurse: evaluates and prescribes medication for emotional difficulties; may provide counseling services.
• Counselor, Social Worker, Psychologist: offers help in talking about emotions and thoughts and helps find ways to manage concerns.
• Spiritual or Faith-Based Leader: counsels on faith-based and spiritual matters.
• Grief and Bereavement Counselor: assists in dealing with death and any type of loss or anticipated loss, including the loss of physical abilities.

For Help with Practical Concerns

• Attorney: develops advance directives and wills.
• Social Worker: coordinates palliative care among all of the different professionals, makes referrals to community and other resources, arranges family meetings, assists with creation of advance directives.

Note: Always check with your health care team before starting any approach that includes a change in physical treatment such as exercise, massage or physical therapy, medication, herbs and vitamins.

Palliative Care at Different Stages of Cancer

Palliative care may be given during treatment and at any time after. Needs change over time, and no two will have exactly the same experience. Palliative care is appropriate whenever you need it – now or in the future. You have the right to ask for the help you need throughout any time during your cancer journey.

Just diagnosed and during treatment:

• Relief from aggressive treatment of adverse effects related to cancer treatment.
• Relief of pain, nausea and other physical symptoms.
• Help with practical concerns including help with transportation, finding caregivers or insurance matters.
• Assistance with legal matters relating to advance directives (written documents that detail your wishes for health care in the event you are unable to express them).
• Planning for rehabilitation services such as physical or occupational therapy.
• Emotional support.

After cancer treatment:

• Ongoing support for survivors and their families to enhance quality of life after cancer treatment.
• A range of services that addresses the survivor’s individual physical, emotional and practical needs.

Nearing end-of-life:

• Care to enhance quality of life as much as possible including physical, emotional and spiritual comfort.
• Pain relief and management of other symptoms.
• Support through hospice services for survivors who have six months or less to live and their loved ones.
• Services provided where the survivor is living by trained hospice professionals and volunteers.
• Spiritual or faith-based counseling as requested.
• Planning of funeral or memorial services.
• Grief and bereavement counseling for family members.

Work closely with your health care team to learn what options may be appropriate for you.

Palliative Treatments and Services

Ask Your Health Care Team About Palliative Care

Start by finding out if your health care team can provide palliative care service. If you have not yet started cancer treatment, ask about treatment options and what side effects and late effects are possible. Ask if there is anything they can do to help you prevent or prepare for possible adverse effects.

Anytime, during or after treatment, it is important to let your health care team know about your feelings and concerns. They can help you with your symptoms or refer you to a professional specialist for help that is right for you.

Questions for your Health Care Team

• How can you help me prepare for possible adverse effects of cancer treatment?
• While I receive cancer treatment? What medications can help?
• What aftereffects are common for my type of cancer and treatment?
• What medications are available to help me manage physical aftereffects?
• Are there other methods that might be helpful to relieve my physical aftereffects?
• Can you refer me to an oncology social worker to help me find the palliative care I need?
• Who should I call if my symptoms are not relieved? Can you refer me to a palliative care certified specialist?
• What types of services or professionals are available to help me with the emotional aftereffects of cancer treatment?
• Who can help me talk to my family and educate them about palliative care?
• What types of services or professionals can help me manage the financial and legal aftereffects of cancer treatment?
• Is there anyone within your office who can help me sort out insurance and financial matters or help me apply for Medicaid?
• How is this type of palliative care typically paid for? Will my insurance cover it?