Misconceptions about palliative care are common

In inpatient settings, family physicians frequently care for patients with progressive, incurable conditions that cause severe pain. Interventions aimed at slowing the progress of a disease often add to patients’ physical distress; therefore, pharmacologic management of pain is a key component of end-of-life care, as outlined in an article in an issue of American Family Physician.

However, as Drs. Timothy Daaleman and Margaret Helton discuss in an accompanying editorial, providing analgesia is only the starting point for effective palliative care:

Palliative care generally begins with diagnosis of a life-limiting disease and initiation of an ongoing conversation on the goals of care and treatment. This often begins in patient-centered medical homes, continues through acute hospitalizations, and may conclude in long-term care facilities. At each point, family physicians may be called on to provide primary palliative care and can expect to encounter nonpharmacologic challenges in managing pain. 

Misconceptions about palliative care are common. For example, many believe that palliative care, like hospice care, cannot be offered to patients who are still pursuing “aggressive” treatments such as chemotherapy for cancer. On the contrary, one of the American Academy of Hospice and Palliative Medicine’s Choosing Wisely recommendations states, “Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.”

Palliative care does not necessarily increase patient comfort at the cost of shortening life; in a randomized trial of patients with metastatic non-small-cell lung cancer, patients assigned to early palliative care not only experienced better quality of life and fewer symptoms of depression than patients receiving standard care, they actually lived more than two months longer.

The recent announcement by a large health insurance company in the Pacific Northwest that it will prioritize palliative care by training physicians and caregivers about having appropriate end-of-life conversations; and pay for previously unreimbursed home health services and counseling about advanced directive planning suggests that policymakers are finally recognizing the value of improving the availability of palliative care to appropriate patients.

What have been your experiences with connecting patients or loved ones to palliative care services?

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor

Comments are moderated before they are published. Please read the comment policy.

  • noshaus

    I’m searching for some answers, a second opinion if you will. I have been led to understand that in Palliative care, medicine must be administered with regard to avoiding side effects, and that Hospice Care may administer medicines without that restriction, solely to alleviate pain. ? My family’s situation is this: My 87yo mother does not have cancer nor has she been given a terminal diagnosis. Her Primary Care MD does see her as hospice appropriate (she is no longer eating much, has lost function of her legs and hands). He also believes that Palliative care as a discipline is unnecessary because he could write ‘scripts for home health and visiting nurses (which he has not offered . . . I must ask?) My mother is in chronic and acute pain all the time and the very strong pain-killers she takes are doing next-to-nothing. As a family, we presented the idea of Hospice Care as the practice of medicine solely dedicated to relieving pain; she sees it as a one way street, a death sentence. My understanding is that Hospice Care is She has now developed the skin conditions that can lead to bed sores if not turned every 2 hrs. Her pain is excruciating and turning her makes it worse. I am under the impression that the stronger pain meds will help even in the turning, so the skin can begin to heal. My line of questioning begins with: what is your opinion regarding the MD’s appraisal of Palliative Care? Is it true that Palliative Care offers the support team of Hospice, but no additional Pain relief? Can a Palliative Care team help guide us in the materials needed (eg, Hospital beds, etc.) in the way that Hospice Care would? Thabnk you for your time and attention.

Most Popular