Practical Issues in Palliative and Quality-of-Life Care

Abstract

Although palliative care is not new to health care or to oncology, oncologists still struggle to maximize the value of this type of care across the entire care continuum and across the patient's trajectory of illness. When we don't use what may be the best tools for the job, at the right times in the care path, we miss opportunities to optimize patient and family coping, to limit suffering, and to ensure that our care plans are patient centered. In this article, we look at how we define palliative care and how the tools of palliative medicine can be used to enhance patient care in the outpatient oncology practice setting.

Outcomes of collaborative and interdisciplinary palliative education for health care assistants: A qualitative metasummary

“…Upstream consideration of the needs of seniors at the time of diagnosis, early during their chronic illness experiences, and up to a year before the end of life is referred to as a palliative approach to care (Pesut, Potter, et al, ; Sawatzky et al, ; Stajduhar & Taylor, ). As a disease progresses and symptom burdens increase, the focus of care shifts from prolonging life to comfort care (Hennessy, Lown, Landzaat, & Porter‐Williamson, ). These authors argue that palliative care should not be viewed as beginning when life‐prolonging treatment ends; it should be concurrent and fluidly shifting between the two.…”

Designing and Testing an End-of-Life Discussion Intervention for African American Patients With Heart Failure and Their Families

“…Fifty percent of all deaths annually in the United States occur in the hospital. 14 However, studies report that at the EOL, people would prefer not to be in the hospital, not to be in pain or discomfort, not to be a burden on loved ones, not to be sustained artificially, and to have religious prayer or pastoral care. 6 To succeed in delivering care concordant with these preferences, patients and families need a better understanding of their illness progression over time and the meaning of related treatment options.…”

“…14 As shown in the Figure, the trajectory depicts typical HF decline and can indicate when conversations with families about EOL care options should be initiated. The trajectory curves are based on the patient’s clinical, functional, and psychosocial measures, such as depression, 16 known to precede HF rehospitalizations and death.…”

“…National reports from HF experts reveal that 38% to 58% of HF patients recover sufficiently to be discharged from hospice, yet all return to a downward illness trajectory. 14 Families must be prepared to manage this situation, and professionals must discuss this possibility with patients, their families, and HF providers. Furthermore, the family’s cultural background must be considered.…”

Delivering High-Quality Cancer Care

“…Clinicians often equate palliative care with end-of-life care and consider it an alternative, rather than a complement, to curative or life-extending treatment (see Box 3-4). However, palliative care services may be introduced at any point along the continuum of cancer care as a critical layer of support that is delivered concurrently with therapeutic treatment modalities to improve quality of life for cancer patients (Ferris et al, 2009;Hennessy et al, 2013;Spinks et al, 2012). In a provisional clinical opinion, ASCO endorsed the provision of palliative care concurrent with usual cancer care .…”