Palliative care

The opposite of giving up

Posted 5/17/23

Former President Jimmy Carter recently elected hospice care after years of treatment for serious illness. It was a life-affirming decision, a choice to preserve his quality of life.

He made the …

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Palliative care

The opposite of giving up


Former President Jimmy Carter recently elected hospice care after years of treatment for serious illness. It was a life-affirming decision, a choice to preserve his quality of life.

He made the decision in consultation with his family and his physicians—no “death panel” was involved; nor was it an example of “rationing” medical resources or limiting access to care.

The first announcement by the Carter Center stated that the choice of hospice care was “instead of additional medical intervention.” 

In fact, hospice care and palliative care are special forms of medical intervention that can be offered to patients and their families at any stage of a serious illness. Care is provided by a team of professionals trained in this form of patient care.

The relief of both suffering and pain are the chief goals of care, rather than the cure of the underlying condition.

The medical representative on the team is usually a primary care physician certified in hospice and palliative medicine by the American Board of Internal Medicine. 

The certificate’s title itself includes two of the more confusing terms in health care— “hospice” and “palliative.” Palliative care is a more general term that encompasses hospice care, which is reserved for those at the end of life. 

As hospice care is a benefit of Medicare, federal legislation passed in the mid-1960s, it is subject to various requirements, such as a “hospice diagnosis” confirmed by two physicians and a limit of six months of care.

Palliative care can be offered to patients of any age and at any stage of a serious illness. The interdisciplinary-team approach is more likely to address pain and suffering caused by a mix of medical, social and psychological sources. This model is employed in all forms of palliative care, including hospice care, hospital- or office-based consultation and post-operative care.

Often a palliative care team initiates a discussion of the patient’s thoughts and feelings about ongoing treatment and proposed future treatment, rather than the patient’s treating doctors or surgeons.

Palliative care consultation should be available to all hospitalized and community-based patients when the need arises. This is, however, not the case—and the greatest reason may be the prevalent misunderstanding of the mission and the essential features of palliative care. 

The confused include members of the medical profession, even physicians facing life-and-death issues in their daily practice.

An article in the Journal of Clinical Oncology in 2012 identifies several reasons health care professionals treating cancer patients give to explain their reluctance to discuss poor prognosis with a patient. 

Here’s the list:

It will make people depressed

It will take away hope

Involvement of hospice and palliative care will reduce survival

We do not really know a patient’s prognosis

Talking about prognosis is not culturally appropriate

We do not like having these discussions and they are hard on us

The authors present current evidence refuting each of these assumptions. Patients want to discuss prognosis and the discussion does not cause depression or hopelessness. Survival is equivalent or better for patients receiving palliative or hospice care. Establishing goals of care is hard work, often requiring a time-consuming family meeting. A palliative care consultant can be a source of support to colleagues less able to conduct difficult discussions.

News of a former president accepting hospice care likely implied imminent death to many of us. This impression is in part due to late referrals to hospice care, often initiated in the last days of life. 

One month after his enrollment in hospice care his life goes on at home, comforted by his family and familiar surroundings, free of the burden of treatment now unlikely to cure.

jimmy carter, palliative care, hospice care, life affirming, seniors


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