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Knowledge Point Articles
March 2006
The Meaning of Hospice and Palliative Care
It is a kind of care that is both a philosophy of care and a
highly structured system for delivering care. It expands traditional
disease-based medical treatments to include the goals of enhancing quality of
life for the patient and family. Also included are optimizing function, helping
with decision-making and providing opportunities for personal growth. This kind
of care just described is palliative care. The World Health Organization’s (WHO)
definition of palliative care is, “An approach which improves quality of life of
patients and families facing life threatening illness through the prevention and
relief of suffering by means of early identification and impeccable assessment
and treatment of pain and other problems, physical, psychosocial and spiritual.”
Often the populations of people included in this description are those with a
life-threatening or debilitating illness who are living with adverse conditions
that will predictably reduce life expectancy. These individuals often have an
advanced illness, yet may be receiving what is considered aggressive treatments
and therapies. Diane Meier, M.D., Director of the Center to Advance Palliative
Care defines palliative care as “Interdisciplinary care that aims to relieve
suffering and improve quality of life for patient and family.”
Reading these descriptions, one might wonder what hospice care is. Something that has assisted those of us having worked in providing palliative care for those dying is the following: Hospice is palliative care, but not all palliative care is hospice. Hospice is and has been the model for quality, compassionate care for those at the end of their life wanting to die comfortably with their family and friends and most often in their own residence. It is care provided by an interdisciplinary team to support the emotional, physical, spiritual psychosocial and financial aspects of pain and symptom management with dignity and driven by patient choice. Dame Cicely Saunders, mother of hospice founder of St. Christopher’s in England said, “You matter most to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die.” In 1982, hospice had also signed in to law, by President Ronald Reagan, the Hospice Medicare Benefit, a specific payment for hospice services to any U.S. citizen with Medicare Part A and a life-limiting illness. Today, most insurance companies and other providers cover hospice services. The hallmarks of hospice care, including volunteer involvement and bereavement (grief) care for the survivors after the death, focus on support and health promotion that can be found in all certified hospice programs.
The care, focus and discussion of palliative care have grown
considerably in the past three years. The Robert Wood Johnson Foundation awarded
six Palliative Care and Leadership Centers (PCLC) around the country to educate
and provide leadership for those health care institutions and providers wanting
more exposure and education to palliative care. The services of palliative care
can hopefully be routinely integrated with disease modifying therapies with a
growing practice specialty. Hospice does focus specifically on end of life. We
hope the care that is best for symptom management can shift hospice from the
brink of death to a more integrated option of care earlier on. When one is
looking at the palliative care for symptom management during life-prolonging
therapy, the discussions can and should include hospice. When the burdens
outweigh the benefits, hospice care is the specialized care to provide
palliation of symptoms for comfort care, including the patient and family as our
unit of care and providing a focus of caring, not curing.
Kate Cummings RN, BSN, PHN
Director of Hospice and Transitions and Life Choice Palliative Home Care Program Fairview Home Care and Hospice
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