Palliative Care: Comfort and Support for Serious Illness

What does palliative care do?

The word "palliative" comes from the Latin pallium, a cloak, meaning to ease or shield from suffering. Palliative care treats the person, not just the disease. A palliative care team works with your other doctors to:

• Control symptoms: pain, breathlessness, nausea, constipation, fatigue, poor appetite, itching, insomnia, anxiety and depression
• Communicate clearly: explain what is happening, what treatments can and cannot do, and what to expect
• Support decisions: help you match treatment choices to your goals and values
• Plan ahead: advance directives, choosing a health care proxy and POLST forms
• Coordinate care: between specialists, hospital and home
• Support the family: caregiver training, respite planning, emotional and practical support, and bereavement support

Palliative care vs hospice

All hospice care is palliative, but most palliative care is not hospice.

Who can get palliative care?

Anyone living with a serious, chronic or life-limiting illness, including:

• Cancer, at any stage
• Heart failure
• COPD and other lung diseases
• Chronic kidney disease and dialysis
• Dementia, Parkinson's disease, ALS, multiple sclerosis and stroke
• Advanced liver disease, HIV, and serious illness in children

There is no prognosis requirement. You do not need to be close to death.

The palliative care team

• Palliative care doctors and nurse practitioners
• Nurses
• Social workers
• Chaplains or spiritual care providers
• Pharmacists, dietitians, and physical and occupational therapists
• For children, child life specialists

Common symptoms and how they are managed

• Pain: a combination of medicines, from acetaminophen (paracetamol) and anti-inflammatories to opioids, nerve pain medicines and steroids, plus radiotherapy for painful bone metastases. Fears about addiction are discussed openly; at appropriate doses under supervision, opioids are safe and effective in serious illness.
• Breathlessness: treating the cause, positioning, a fan blowing on the face, breathing techniques, oxygen when levels are low, and low-dose opioids, which reduce the sensation of breathlessness.
• Nausea and vomiting: choosing an anti-nausea medicine that matches the cause.
• Constipation: a regular laxative plan whenever opioids are prescribed.
• Fatigue and poor appetite: adjusting expectations, light activity, small frequent meals and treating anemia or depression.
• Anxiety, low mood and insomnia: counseling, medicines and spiritual support.

Benefits of early palliative care

Research, including a well-known 2010 trial in advanced lung cancer, found that people who received palliative care early alongside cancer treatment had better quality of life, less depression and less aggressive care at the end of life, and in that study lived slightly longer. Major oncology and heart failure guidelines now recommend early referral for advanced disease.

How to get palliative care

1. Ask your primary care doctor or specialist for a palliative care referral. You can ask at any time.
2. If you are in the hospital, ask whether there is a palliative care consult team.
3. Check your insurance for outpatient and home-based palliative programs.
4. Prepare for the first visit: list your symptoms, medicines, questions and what matters most to you.

Common myths

• "Palliative care means giving up." It is given alongside active treatment.
• "It is only for cancer." It helps any serious illness.
• "It is only for the last days." The earlier it starts, the more it helps.
• "Accepting it means I will lose my own doctors." Your doctors stay in charge of your disease treatment.

Frequently asked questions

What is palliative care?

Palliative care is specialized medical care for people living with a serious illness. It focuses on relieving pain and other symptoms, reducing stress, helping with difficult decisions and supporting families. It can be given at any stage of illness and alongside treatments aimed at curing or controlling the disease.

What is the difference between palliative care and hospice?

Palliative care can start at diagnosis and continues alongside curative treatment. Hospice care is a type of palliative care for people in the last months of life, usually with a prognosis of 6 months or less, when curative treatment has stopped. Hospice has its own Medicare benefit in the US.

Does palliative care mean you are dying?

No. Many people receive palliative care for years while having treatments such as chemotherapy, dialysis or heart failure therapy, and some recover from their illness. Palliative care is about living as well as possible with a serious illness, whatever the outlook.

Who qualifies for palliative care?

Anyone with a serious illness that affects their quality of life can receive palliative care, including cancer, heart failure, lung disease, kidney disease, dementia and neurological conditions. There is no age limit and no requirement for a short life expectancy. A referral from your doctor is usually the first step.

Is palliative care covered by insurance?

In the US, palliative care is generally covered like other specialist medical services by Medicare Part B, Medicaid and most private insurers, with usual copays. Home-based programs vary by plan and area. Hospice care, by contrast, is covered under the separate Medicare Hospice Benefit with little or no out-of-pocket cost.