Patient Guidelines for Palliative Care

Palliative medicine is specialized medical care for people with serious illnesses. It provides evaluation of disease states, recommendations for symptomatic treatment options and consideration of alternative treatment and care choices.

What Are the Goals of Palliative Medicine?

The goal of palliative care is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses and other specialists who work with a patient's primary care physician and other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.

Palliative Care Guidelines

An interdisciplinary palliative care team addresses everything from pain management to crises of faith to weight loss to community resources. They work with newly diagnosed patients and those struggling with the after-effects of curative therapies. Some members of the palliative team may be board certified in hospice and palliative medicine; others range from chaplains to acupuncturists.

A palliative consult with your patient provides timely and specific information that helps the patient and family understand what palliative medicine brings to the table, and helps you provide the most appropriate care.

Who is Eligible for Palliative Care?

Consider a palliative care consultation for your patient if:

• The care team, patient or family needs help with complex decision-making and determination of goals of care. Goals of care are derived when a medical professional has an open and guided discussion of:
  • Uncertainty of prognosis
  • Uncertainty of appropriateness of therapy options
  • Uncertainty of end-of-life status and/or hospice appropriateness
• Divergent views over care exist. Here are some scenarios:
  • The patient and/or family request care that team feels is ineffective and probably have unsuccessful outcomes.
  • There are conflicts over DNR orders.
  • There’s recognition of limited therapeutic impact of artificial nutrition and hydration in a cognitively impaired, seriously ill or dying patient.
  • Family distress is resulting in possible impaired surrogate decision-making.
• There’s a presence of threshold situations that possibly predict of further decline:
  • New diagnosis of life-limiting illness
  • Declining function with decreased ability to complete activities of daily living
  • Unrelenting, unexplained weight loss
  • Hospital admission from long-term care facility
• These conditions are present:
  • Metastatic cancer with failure of multiple regimens of treatment
  • Neurologic complications of cancer
  • Brain metastases
  • Spinal cord compression
  • Carcinomatous meningitis
  • Advanced lung disease with frequent exacerbations
  • Advanced cardiac disease requiring consideration of LVAD or IV pressors
  • Advanced renal disease with deterioration despite dialysis
  • Neurodegenerative disease considering feeding tubes or ventilator support
  • Anoxic encephalopathy
  • Stroke with resultant function decreased by 50 percent, considered life-limiting
  • Catastrophic multiple trauma
  • Continued use of a ventilator

Settings of Care

Palliative care has evolved from being only a hospital-based model to now being available in many outpatient care settings. In the home, it can be a supportive care model. The availability of such options depends upon the support of medical providers and/or insurance coverages. VITAS Healthcare supports many care models and settings.