Description

• The principal goal of palliative care is to prevent and alleviate suffering—whether physical (pain, breathlessness, nausea, etc.), emotional, social, or spiritual regardless of the underlying etiology.
• Palliative care is an interdisciplinary approach to caring for patients and families that aims to improve or maintain quality of life despite serious illness.
• The palliative care team helps to identify goals of care based on patient preferences and values.
• Hospice: In the United Sates, hospice is available for patients whose average life expectancy is ≤6 months and whose principal goal is to stay at home (including long-term care or assisted living facility), avoid hospitalizations, and forego disease-directed care with a curative intent. Unlike regular home nursing services, hospice does not require a patient to be homebound. Hospice offers backup support for patients 24 hours a day and 7 days per week. Hospice will also provide bereavement support for family and friends for 1 year after the patient’s death.

Risk Factors

• Cancer
• Early-onset dementia
• Advanced heart failure

Commonly Associated Conditions

Common symptoms/syndromes encountered in palliative care:

• Pain: chronic pain, neuropathic pain, pain from bone metastases
• GI symptoms: ascites, anorexia/cachexia, bowel obstruction, constipation and stool impaction, diarrhea, dysphagia, mucositis/stomatitis, sialorrhea, xerostomia, nausea, and vomiting
  • For nausea and vomiting consider underlying etiology and treat accordingly.
    • GI causes: constipation, bowel (full or partial) obstruction, ileus, reflux, inflammation
    • Intrathoracic causes: cardiac, effusions (cardiac, pulmonary), mediastinal causes, esophageal disease
    • Autonomic dysfunction
    • Centrally mediated: intracranial pressure change, inflammation, cerebellar, vestibular, medication or metabolic cause stimulating vomiting center, and/or chemoreceptor trigger zone
    • Medication side effects
• General medical symptoms: delirium and fatigue
• Pulmonary symptoms: cough, breathlessness, dyspnea
• Psychological symptoms: anxiety, depression, insomnia
• Skin: decubitus ulcer, pruritus, complex wounds