This is the final post in the series on dealing with pain. The other two posts dealt with acute and chronic pain.
Depending on the individual, as well as diagnosis, treatment, side effects etc., people can experience a level of discomfort that can be very problematic. It can be pain, but issues such as shortness of breath, fatigue, constipation, nausea, loss of appetite, or difficulty with swallowing or sleeping, can compromise quality of life.
Both hospice and palliative care use the term “comfort care,” to manage pain and related symptoms that can accompany end of life, serious illness, and/or during the course of treatment. Note that this is different than a person under going surgery. The surgical and medical staff will manage this type of pain.
Both hospice and palliative care have the common goal of improving quality of life and both help the person and their family deal with end of life issues and bereavement. However, there are some key differences between the programs.
Hospice is provided when a person is expected to die within six months and the only treatment provided will be comfort care. Palliative care provides similar comfort and pain control measures but allows the patient to pursues active treatment for their condition. There is no time constraint with palliative care. Medical centers as well as home health/visiting nurses provide palliative services for a variety of conditions such as ALS, MS as well as cancer. While some hospitals do provide in-patient hospice, and there are free standing hospice facilities in various parts of the country, the majority of people receiving hospice are at home and receive care via home health/visiting nurses.
Because people respond differently to treatment, as well as their specific condition, comfort care is very individualized. For example, hospice provides a “comfort care pack” that is placed in the refrigerator to be used as needed. This pack will contain the basics for controlling pain and some of the more frequent side effects, such as constipation and nausea. Based on the diagnosis and the particular needs of a patient, there could be a variety of other treatment options, such as anti seizure medications for a patient with brain cancer.
Even though hospice care is highly regarded by patients, family and medical providers, for some the implications of being a hospice patient, recognizing that they are dying, is not something they are ready to accept. In such situations, palliative care is an excellent option, as pain and symptom control are key goals of both programs. Further, if the person is at home, a good working relationship can be established with the visiting nurses. Often times the staff for palliative care is the same one for hospice, so a smooth transition can occur if the person switches to hospice.
Regardless of diagnosis or life expectancy, pain and other symptoms can quickly destroy quality of life, thereby impacting not only daily living but also life expectancy/. A study of 151 patients with metastasis lung cancer were randomized to have monthly visits with palliative care and routine cancer treatment or just routine cancer treatment found that those receiving palliative care not only lived longer, but had much better pain control, fewer hospitalizations, less anxiety and depression. New England Journal of Medicine
Dealing with Pain: Acute
Dealing with Pain: Chronic
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National Hospice and Palliative Care Organization