Palliative care

Palliative care is a specialized medical approach designed to optimize the quality of life for people facing serious, complex, or terminal illnesses. The term originates from a Latin root meaning "to cloak," which reflects its goal of shielding patients from suffering. Unlike treatments that focus solely on curing a disease, palliative care focuses on mitigating physical, psychosocial, and spiritual distress. It is an interdisciplinary method, meaning it uses a team of experts from different medical fields to treat the whole person. This care is appropriate for patients across all age groups. It can be provided as the primary goal of care or alongside curative treatments intended to prolong life.

To provide this care, an interdisciplinary team works together to address various needs. This team often includes physicians and nurses to manage physical symptoms. Occupational and physical therapists assist with movement and daily functions. Psychologists and social workers provide emotional and social support, while chaplains address spiritual needs. Dietitians may also join the team to manage nutrition. This team-based model ensures that care is tailored to the specific preferences and needs of the patient. By working in coordination, these professionals can provide support in many settings, such as hospitals, outpatient clinics, or the patient's home.

Historically, the field of palliative care grew out of the hospice movement. In 1967, Dame Cicely Saunders founded St. Christopher's Hospice for the terminally ill. In 1969, Elisabeth Kübler-Ross published her influential work, "On Death and Dying." The specific term "palliative care" was coined by Balfour Mount in 1974. Later, in 1987, Declan Walsh established a palliative medicine service at the Cleveland Clinic in Ohio. This service eventually became a training site for the first clinical and research fellowships in the field. Women played a central role in this history, particularly by expanding services to include frail elderly patients through geriatric palliative care.

There are important distinctions between palliative care and hospice, especially in the United States. In the U.S., hospice is a specific federal benefit that has existed since 1982. While both share goals of comfort and pain control, hospice is generally reserved for patients with a prognosis of less than six months to live. Under the Medicare Hospice Benefit, patients often forego curative therapies to receive specialized hospice services. However, outside of the United States, the terms are often used synonymously. In many other countries, hospice refers to a specific building or institution that provides palliative care for those nearing the end of life.

The scope of palliative care is vast and addresses several critical sectors of healthcare. First, it provides physical and emotional relief through symptom management. Second, it strengthens communication between patients and physicians to improve decision-making. Third, it ensures coordinated continuity of care across different settings, such as moving from a hospital to a home environment. A key concept in this field is "total pain." Introduced by Cicely Saunders in the 1960s, this term describes how pain is not just physical. It is a combination of physical, psychological, social, and spiritual factors that are all closely linked.

Global statistics highlight both the necessity and the challenges of accessing this care. Every year, approximately forty million people are expected to need palliative care. About 78% of this population lives in low and middle-income countries. However, only 14% of those in need actually receive it, with the majority of care being available in high-income countries. In the United States, over 40% of dying patients currently undergo hospice care. Most of this care occurs in a home environment during the final weeks or months of life. Among those receiving hospice care in the U.S., 86.6% report that their care was "excellent."

Medical practice in palliative care involves various tools to manage symptoms effectively. Doctors may use common medications, such as morphine, antipsychotics, or anticonvulsants, but for different reasons than in acute care. Because many patients lose the ability to swallow, medical professionals use different routes of administration. Subcutaneous administration, which is given under the skin, is often used because it is less traumatic than intravenous methods. Other methods include sublingual (under the tongue), intramuscular, and transdermal (through the skin) routes. These interventions can be managed by family members or nursing support at home.

Research shows that implementing palliative care can lead to significant benefits for the entire healthcare system. Evidence suggests that hospital palliative care teams can create significant cost savings for health systems. For patients with advanced cancer, receiving palliative care alongside standard oncologic care is associated with lower rates of depression and an increased length of survival. It also improves overall symptom control and family satisfaction. While over 90% of large U.S. hospitals have these teams, only 17% of smaller rural hospitals currently provide them. This highlights an ongoing need for expanded access to these essential services.