Cancer Patient Guide
[ End of Life Issues ]
Palliative Medicine strives to improve the quality of patients’ lives, while at the same time trying to increase understanding of the most likely outcome of advanced illness and elicit patients’ treatment preferences and goals for their future care. It is of the utmost importance to determine what type of care each patient wants so that it may be tailored to his or her wishes. An important goal of palliative medicine is to avoid painful and ineffective treatment interventions that may not be of benefit and might even add to suffering. Open, honest communication about treatment options and expected outcomes is vital to accurate decision making since good decisions require good information. Although these discussions are often time consuming and challenging, they are essential if each patient is to receive care that is most appropriate to his or her physical requirements and is consistent with his or her personal values.
In addition to identifying each patients’ personal goals and treatment preferences, palliative care strives for the relief of suffering, whether it be physical pain, or suffering in the psychosocial or spiritual sense. The utilization of appropriate medical management of symptoms can greatly improve the quality of life for patients, while the participation of interdisciplinary team members (chaplains and social workers) can assist in the relief of non-physical suffering. Palliative medicine may also be an extra layer of care added to a curative or active treatment plan, or, in some instances, may be the sole focus of care. Palliative medicine may also include hospice care, defined as the relief of suffering and promotion of quality of life for those patients in the last six months of life.
By discussing a person’s treatment preferences and what kind of medical care is or is not acceptable to that individual, the palliative medicine specialist also focuses on “advance care planning.” A written plan allows the medical team and family to know what to do for a person should circumstances arise relating to renal, respiratory, and/or cardiac failure, or death. Having a plan for such situations can help facilitate a family’s decision making in a time of crisis and ensure that medical interventions are appropriately pursued or withheld in accordance with a patient’s wishes.
Federal law requires that hospitals ask if patients have an “Advance Directive.” This document specifies each person’s individual health care preferences in case he or she is unable to communicate his or her wishes during a medical crisis. These directives commonly take the form of a “Living Will” or a “Durable Power of Attorney for Health Care.” Please consult an attorney, hospital social worker, physician or nurse for additional information.
Hospice care is designed to make patients comfortable during the final stages of their illness. The hospice team is comprised of physicians, nurses, pastoral counselors and volunteers who provide all possible help either in a person’s home or a hospice facility. The hospice team uses an aggressive approach to pain control (for example, localized radiation therapy may be used to relieve bone pain) and helps patients and families deal with physical and emotional issues that accompany death, dying and grieving.
Patients can ask their physician for a referral to hospice care for a variety of reasons. If told by their physician that their disease is incurable and that further treatment would either not reduce symptoms or might even increase discomfort, patients may decide to forgo further treatments. Hospice care is also appropriate for patients having difficulty taking care of their daily needs or coping with symptoms such as pain or nausea that are difficult to manage.
A physician may need to certify that the illness is terminal (with a life expectancy six months or less) before a patient can be accepted into a hospice program.