National Healthcare Decisions Day: Understanding Palliative Care

Monday, April 9, 2012

This post is Part 1 of 4 in our National Healthcare Decisions Day series


Comedian Mitch Hedberg once said “I had a stick of CareFree gum, but it didn’t work. I felt pretty good while I was blowing that bubble, but as soon as the gum lost its flavor, I was back to pondering my mortality.”

Sometimes it seems easier to joke about life and death than to have the important conversations surrounding our own mortality.

That’s what National Healthcare Decisions Day, on April 16th, is all about. It’s a day designed to open these most difficult lines of communication about a topic most everyone tries to avoid.

It’s a challenge to make decisions today, while you can, so others don’t have to make them for you later. It’s not easy, but it’s needed.

For more information click here.

Two common terms concerning end of life care are: palliative care and hospice.

They are different, as Dr. Alfred Levy, director of Supportive and Palliative Care at Baylor Regional Medical Center at Plano and The Heart Hospital Baylor Plano explains:

The Supportive and Palliative care (SPC) specialist focuses on symptom relief and guidance to patient’s with serious and most often life limiting illnesses. The illness may be cancer, congestive heart failure, dementia, organ failure or any major medical illness.

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

Longevity is not an issue as it may be in hospice. In fact, longevity and quality of life are equally important in Palliative Care. The balance and the timing are the issues.

In hospice, the primary care goal is comfort treatment of the underlying illness and this is primarily limited to the last six months of life.

That is worthy in its own right but may be limiting in continuing treatment or when we do not actually have a firm prognosis when life may end.

The SPC specialist is uniquely positioned to help coordinate the interventions and the amount of intervention before that point when Hospice may become a desirable option.

There is a difference between the services offered by hospice which is an outside non-Baylor service limited to end of life issues in the last six months. Supportive and Palliative care service at Baylor is a Baylor Medical staff consulting service just like any other consultation service such as cardiology, nephrology, oncology or surgery.

Often, we are in the best position to help the patient and family decide if something should be done or not.

The primary difference between palliative care and hospice is that the palliative care specialist is focused not only on relieving the symptoms burden but also continuing to treat and support/coordinate with the other medical specialties that are treating the underlying serious illness. After all, one the best ways to palliate or relieve symptoms is to improve the primary disease.

For some patients who do not get better with primary disease treatment palliative treatments may supersede treatments that are no longer working or may become a bridge to hospice services. Supportive and Palliative care services at Baylor Plano and THE HEART HOSPITAL Baylor Plano are offered as a consultation based service and are available as outpatient and inpatient services.

Supportive and palliative care consultation has clinically proven benefits, including better symptom control, less emotional hardship on patients and families, and improved care planning/coordination. A recent New England Journal article from 2010, showed that in one study of metastatic non-small cell lung cancer patients, that the patient’s had improved outcomes in terms of quality of life, mood, and more appropriate care at the end of life but also in fact lived longer than those who did not have palliative care.

Another facet of the supportive and palliative care service is the active inclusion of the patient in making advanced directives which include living wills, medical power of attorneys and other important decisions.

Supportive and palliative care service strives to help improve the symptoms of physical pain, or distressing symptoms of life limiting illness. We help improve emotional pain, depression and anxiety. SPC is a multidiscipline team of social work, care coordination, registered nursing, advanced practice nursing and pastoral care all working together as a team.

To learn more about advanced care planning click here.

This blog post was contributed by Dr. Alfred Levy, medical director, supportive and palliative care, Baylor Regional Medical Center at Plano and The Heart Hospital Baylor Plano

Series NavigationNational Healthcare Decisions Day: Advance Care Planning

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