Introduction to Palliative Care
Dr. Sandhya Bhalla-Regev, MD
Position
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Palliative care is the right of every
individual suffering from incurable illness.
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Palliative care (pronounced pal-lee-uh-tiv) is
specialized medical care for people with
serious illnesses. It focuses on providing
patients with relief from the symptoms, pain,
and stress of a serious illness—whatever the
diagnosis.
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The goal is to improve quality of life for both
the patient and the family.
What is Palliative Care?
Difference between Palliative care and
Hospice programs
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Curative care is directed at healing or curing a
disease....like taking an antibiotic for a bladder
infection, Vitamin C if you have scurvy or receiving
therapy following a stroke.
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Palliative care involves offering care that helps
relieve the symptoms, but does not cure or treat the
cause of a disease...like getting a massage for a stiff
neck and sore shoulder which is caused by a
ruptured disc in the cervical spine. The massage
helps alleviate some of the pain, but does not cure
the spinal defect.
Care Defined
Treatments and interventions that enhance
comfort and improve quality of life.
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No specific therapy is excluded from
consideration.
Palliative
Treatments
From a patient perspective:
Why Palliative Care?
Palliative Care in the Elderly
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Mr. H is an 80 year old male with advanced
Parkinson’s disease
He was a neuroscientist until retiring 10 years ago.
Diagnosed with Parkinson’s Disease 10 years ago
He can no longer walk, is wheel chair to bed bound,
cannot make his needs known
He is dependent on caregivers for feeding, toileting,
dressing, walking and transfers.
He has been married for 55 years.
He has two children who live in other states
His wife is his sole caregiver and distraught over his
decline and feels very guilty about making decisions
for her husband.
Mr. H’s Story
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Mr. H has been hospitalized many times for
UTI and pneumonia
Mr. H has been losing weight.
Mr. H gets agitated when doing personal care.
Mr. H has just moved to and RCFE due to
continued decline
He Suffered from pain from contractures in his
legs and arms
Mr. H’s Story Continued
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Palliative Care Consult requested to discuss goals of care with
Mrs. H and children.
His wife confirmed that what gave meaning to Mr. H’s life was
his intellect and his family
She felt that he would not have wanted to continue getting
aggressive treatments
Started on methadone for pain management
Mr. H went onto hospice care and a month later went into
respiratory distress from aspiration and died of pneumonia
His family members were much more prepared after going
through discussions with the palliative care team
1. Address pain and other uncomfortable
symptoms.
2. Assist patients with difficult decision making.
3.Coordinate care with other providers to help
patients navigate the health system.
4. Guide patients to make a plan for living well
based on their needs, concerns and goals.
5. Address code status/POLST.
6.Provide advanced illness prognostication.
Palliative care consult
Expected Benefits of Palliative
Care
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Relief from symptoms, such as;
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Pain
Shortness of breath
Fatigue
Constipation/Diarrhea
Nausea/Vomiting
Loss of appetite
Difficulty sleeping
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Palliative care is provided by a team of doctors,
nurses, social workers and other specialists
who work together with a patient’s other
doctor(s) to provide an extra layer of support.
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The care team may also include, clergy,
massage therapists, pharmacists, nutritionists
and others as needed per specific patient needs.
Who Provides Palliative
Care?
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The palliative care team works in partnership
with you own doctor(s) to provide an extra
layer of support for you and patient and family.
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The team works together to provide additional
support for communication, navigation of the
health system and symptom management.
What About my Doctor?
Where can I receive palliative
care?
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Palliative Care is provided in a variety of
settings.
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Hospitals
Outpatient clinics
Home
Hospice
Long term care facilities (skilled nursing homes)
1. Presence of a serious illness :
Cancer
advanced COPD
CVA
ESRD
Advanced Heart Disease
Liver Disease
ALS
HIV
Alzheimer’s Dementia
Criteria for Palliative Care Consult
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Declining ability to complete ADLs
Weight loss or considering tube feeding
Metastatic cancer despite treatments
Two or more hospitalizations in 3 months
Difficult to control physical or emotional
symptoms
Patient, family uncertainty regarding treatment
Family distress impairing decision making
2. And one or more of the following…
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Most insurance plans, including Medicare and
Medical, cover palliative care.
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If cost is a concern, a social worker or financial
consultant from the palliative care team can assist
in determining your options.
Who Pays for
Palliative Care?
Ask for
it!
Tell your doctors, nurses, family
and caregivers that you want
palliative care.
How Do I Get Palliative Care?
Get Palliative Care.Org
Resources
To cure sometimes, to relieve
often, to comfort always
Questions???