Understanding Palliative Care

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Helen Sorenson, MA, RRT, FAARC

Palliative care, hospice, end-of-life care… these are all the same thing, right? Simply put, no, they’re not. The fact is that most patients and healthcare professionals really do not understand palliative care.

Not long ago, a fourth-year medical student did some research then wrote an article titled; What’s in a name? Is palliative care too loaded? Stop and think for a minute (before you read any further)…what do you think palliative care is? If you answered end-of-life care, please read on…because it is a lot more than that.

Palliative care is “physical, social, psychological and spiritual support given to patients with a life-limiting illness.”

So, what’s a life-limiting illness? Let’s see… cancer, heart disease, COPD, pulmonary fibrosis, pulmonary hypertension, diabetes, pneumonia, liver disease, kidney disease…Is each of these diagnoses a “life-limiting” illness? Yes, no doubt about it. But do all these diagnoses require end-of-life care? No, not necessarily. However, all these diseases/conditions are certainly more manageable when patients are provided palliative care, because palliative care is bothersome symptom control.

Palliative Care in COPD Let’s go back to that fourth year medical student. She conducted a telephone survey of 169 patients with advanced cancer. All were asked the same question about the need for future services. Half of them were asked using the term “palliative care” and half of them were asked using the term “supportive care.” The patients who heard the term “supportive care” in regards to future needed services, rated their understanding, and future perceived need for these services, significantly higher than those who heard the term “palliative care.” So, is palliative care a term that frightens people? Most likely it is. And unfortunately this is not surprising because the term palliative care is often not used correctly by health care professionals! It is commonly used interchangeably when discussing hospice and end-of-life care.

As individuals impacted by COPD – whether you are a person diagnosed with COPD, a family member and / or caregiver – you deserve to know the facts. Examples of palliative care for those diagnosed with COPD may be: supplemental oxygen, adequate hydration, anti-depressants, anti-anxiety medicine (both in low doses), pulmonary rehabilitation, CPAP, pursed-lips breathing, cool fans circulating air in the home, cough suppressants, even very low-dose morphine for those with severe dyspnea. Whatever the bothersome symptoms are that affect the quality of life for an individual affected by COPD, can and should be addressed.

So, do we dare ask if having palliative care actually help a patient live longer? In one study doctors found that patients with terminal lung cancer who were started on palliative care immediately after diagnosis were not only were happier, more mobile and in less pain as their disease progressed, but they lived nearly three months longer. This confirmed what palliative care specialists had long suspected – that early intervention with palliative care in patients with a terminal disease may result in longer life, but most certainly a better quality of life for patients.

Why wait until someone is at the end-of-life to make them comfortable? Why not use the information, technology, and medical advances we have to make individuals with a life-limiting illness as comfortable and active as we can? When we know that quantity of life is going to be shortened by a disease, why not do all we can by using palliative care to make a great difference in the quality of life?

Helen Sorenson MA RRT FAARC is a retired Associate Professor of Respiratory Care at the University of Texas Health Science Center, San Antonio, Texas.

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