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by Donna Morgan
Director of Patient Care Services
What is Palliative Care?
Whether it is called "palliative care" or "comfort care," hospice affirms
life, and regards dying as a natural process of life. The goal is not to cure,
but to provide comfort while maintaining the highest possible quality of life.
Palliative care neither hastens nor postpones death. Palliative care seeks to
relieve suffering, control symptoms, and restore ability, while considering
personal, cultural, and religious values, beliefs, and practices of the
individual and the family. It is the holistic management of physical,
psychological, social, spiritual, and other needs.
Hospice is a form of palliative care. The focus of palliative care in hospice is
on compassionate care for the living, making end-of-life decisions, and the
achievement of a death consistent with the values and desires of the patient.
Palliative care in hospice acknowledges that dying is a normal part of life, and
yet the care does not end with the death of the patient. Support continues for
the family for at least the first year after the death.
Can Chemotherapy and/or Radiation Therapy be a part of Palliative Care?
 In some instances, chemotherapy and/or radiation therapy can be a planned
component of a palliative care program. An example of an indication for either
chemotherapy or radiation therapy would be cancer pain unrelieved despite
appropriate and adequate use of pain medications. If the goal of treatment is to
relieve a symptom which can not
be relieved by any other method, chemotherapy or radiation therapy might be
utilized as a part of the hospice plan of care. This decision is made by the
patient, physician, and the hospice team, and the overall quality of life is a
significant consideration in this decision process.
Are IV fluids part of Palliative Care?
IV fluids might be a part of comfort care, although in most instances the
addition of IV fluids cause difficult to control symptoms, such as fluid
overload, edema, and heart failure. The dialogue regarding the use of IV fluids
is best addressed by the patient, physician, and hospice team, with
consideration given for the goal of the IV fluids.
How is pain controlled in Palliative Care?
Pain control should be the most aggressive component of a palliative care
program. Pain can be controlled in almost all patients, typically with oral
medications (medications by mouth) given around the clock. Based on World Health
Organization guidelines, most hospice programs have discovered that IV pain
medications are only occasionally indicated, and that injections are rarely if
ever utilized. The key to effective pain control is that the patient receives
the correct type of medication, given in the most effective method (again,
usually by mouth), given in appropriate doses, and in conjunction with other
medications which can add to the effectiveness of the pain medication. For
example, pain in the nerves (typically in the feet and hands, and often a side
effect of chemotherapy) is not eased with usual pain medications, but can be
controlled by the daily administration of an adjuvant medication. Bone pain,
often the result of the spread of cancer to other parts of the body, is also
untouched by pain medications, but is easily controlled with the use of an
over-the-counter analgesic. The physician and the hospice professionals will
work together to achieve maximum pain control while maintaining alertness and
ability.
For any other question about pain control at Columbus Hospice call or
email Donna Morgan.
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