Palliative Care and Consulting Palliative Care

What is palliative care?

Palliative care is a specialty focused on quality of life for patients facing serious illness. Palliative care aims to relieve suffering for all stages of disease, regardless of curability or current treatment aims. Palliative care provides care in conjunction with a patient’s primary physician and
specialists. While palliative care does specialize in hospice care, they care for patients not interested in or eligible for hospice.

In what ways can palliative care help?

• Symptoms: assist patients with serious illness who have severe, uncontrolled, or complex symptoms (pain, dyspnea, nausea, constipation).
• Communication: help communicate big picture discussions.
• Disposition: help set up hospice care or follow up in outpatient palliative care clinic. Palliative care can also help transfer a patient to the palliative care unit (PCU).

When to consult palliative inpatient (vs outpatient referral)?

Not all patients with end-stage illness (i.e. new metastatic cancer diagnosis) require inpatient palliative care consultation. If a patient is likely to discharge and their symptoms are adequately controlled, an outpatient referral may be most appropriate. Not all patients discharging with hospice care require palliative care consultation.

These patients may require inpatient consult:

• Patient with complex symptoms that are inadequately controlled (ex: pain crisis, malignant SBO with uncontrolled nausea).
• Complex psychosocial and/or family dynamics.
• Discharging to hospice with complex needs (ex. NGT to suction).

How do I introduce palliative care to a patient?

Some patients may have a negative impression due to misconceptions (i.e. equating palliative care with hospice care) or may not have heard about palliative care. It can be helpful to ask a patient what their understanding is.

• Example: Ms. Smith, 78F with severe COPD presents from SNF for a 3rd exacerbation in 6 months despite appropriate therapy. She weaned from BIPAP and her oxygen requirement has stabilized. She is frustrated by her recurrent hospitalizations and wants to maximize time outside the hospital. Your team discussed code status, but she is conflicted about "not doing everything" and wants to remain full code. Your team wants to consult palliative care for a goals of care discussion.
  • "Ms. Smith, the last 6 months sound challenging. Despite taking your medications, we're concerned that your COPD may be worse." "That's what I figured. I'm tired of being in the hospital every other month."
  • "We think It may be a good idea to introduce you to our palliative care team. Have you heard of palliative care before?" "Is that for people with 6 months to live? I don't want that. I heard you have to stop some of your medications, and I want to use my inhalers."
  • "You might be thinking of hospice care. Palliative care is a specialty that supports patients with serious illnesses like COPD and aims to reduce suffering and maximize quality of life. We often involve them to support someone with a chronic Illness who has been hospitalized multiple times. They can help with managing symptoms and creating a plan for what you would want if you were to become sicker. Think of them as an extra layer of support. You do not have to stop any of your medications. I really think having the palliative care team will help us manage your care better.” "Yes, I would like to speak with them!"