Palliative care is any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease or slows its progress rather than providing a cure. It aims at improving quality of life, and particularly at reducing or eliminating pain.
The World Health Organisation (WHO), in a 1990 report on the topic, defined palliative care as "the active total care of patients whose disease is not responsive to curative treatment". This definition stresses the terminal nature of the disease. However, the term can also be used more generally to refer to anything that alleviates symptoms, even if there is also hope of a cure by other means; thus, a more recent WHO statement [1] calls palliative care "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness". In some cases, palliative treatments may be used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherapy.
The term is not generally used with regard to a chronic disease such as diabetes which, although currently incurable, has treatments that are (ideally) effective enough that it is not considered a progressive or life-threatening disease in the same sense as cancer.
Though the concept of palliative care is not new, in the past most doctors have concentrated on aggressively trying to cure patients, so that concentrating on making a patient comfortable was seen as "giving up" on them. In recent times the concept of having a good quality of life has gained ground, although many would argue that there is a long way to go yet. A relatively recent development is the concept of a health care team that is entirely geared toward palliation; this is often called hospice care.
Hospice care
Hospice care occurs in free-standing hospice units, homes, and (more rarely) within regular hospital units. More than a place, hospice care is a philosophy. It is characterized by concern for symptom relief, general well-being, and spiritual/existential comfort for the dying. The need to maintain quality of life in dying or "quality of dying" is important as the incidence of chronic illness increases with the aging of the Western world's population.
The patient and family are the focus of hospice care, with emphasis placed upon the well-being of family caregivers as well as the patient. Opportunities for caregiver respite are one of the services hospices provide to promote caregiver well-being. Major aspects of hospice care include the relief of pain (analgesia) and management of other symptoms such as nausea and respiratory distress, as well as psychological help for patients and their families to cope with the impending death.
Hospice history
Hospice is a relatively recent concept that originated and gained momentum in the United Kingdom after the founding of the first modern hospice, St. Christopher's Hospice in 1967. Dr. Cicely Saunders is regarded as the founder of the hospice movement. Since its beginning, the hospice movement has grown dramatically.
The first hospice in the United States was established in 1974. In the U.S., hospice care is provided by a core interdisciplinary team consisting of physicians, registered nurses, chaplains, social workers, and the family. The focus of the team is to optimize symptom relief and function in people with terminal illness. Additional members of the team are likely to include home health aides, volunteers, personal care assistants, and housekeepers.
Board certification for physicians in palliative care is through the American Board of Hospice and Palliative Medicine.
Alternative medical treatments such as relaxation therapy [2][3], massage [4], music therapy [5], and acupuncture [6] can relieve some cancer-related symptoms. Treatment that integrates complementary therapies with conventional cancer care is integrative oncology .
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Last updated: 06-02-2005 13:46:01
