nurse comforting older patient

POV: Understanding palliative and hospice care

How specialized nursing supports quality of life for patients with chronic, terminal illnesses
November 27, 2019

November is National Hospice and Palliative Care Month and this year’s theme is, “It’s about how you live.” Angela Mulcahy, PhD, RN, CMSRN, CHSE, clinical assistant professor at the Texas A&M University College of Nursing, provides insight on how nurses provide palliative care to patients living with chronic illness to support quality of life, and how it differs from hospice care.

What is palliative care?

Six in 10 adults have a chronic illness, according to the Centers for Disease Control and Prevention’s National Center for Chronic Disease and Health Promotion. As chronic illnesses progress, patients become increasingly more ill, which often requires specialized nursing to adapt or modify the care provided. Palliative care is patient- and family-centered care focused on symptom management and quality of life.

Developed to meet the needs of an aging population, palliative care takes an interdisciplinary approach to care that focuses on pain, symptoms of the illness(es) and psychosocial support while continuing proper medical treatment. Palliative care is available to anyone with a serious illness and can be a beneficial part of a patient’s overall health management plan.

The goal of palliative care is to relieve suffering and support quality of life. The National Consensus Project defines palliative care as care:

  • Provided over time based on need and found beneficial when provided with ongoing treatments
  • Focused on what is important to the patient
  • That is holistic, incorporating interdisciplinary teams to meet a patient’s needs
  • Offered in any setting in which medical care is provided.

To support the interdisciplinary approach to providing quality care, the National Consensus Project Guidelines provide eight domains of care to offer structure for health care teams that support patients through palliative care:

  1. Structure and Process of Care
  2. Physical Aspect of Care
  3. Psychological and Psychiatric Aspects of Care
  4. Social Aspects of Care, Including Advanced Care Planning
  5. Spiritual, Religious, and Existential Aspects of Care
  6. Cultural Aspects of Care
  7. Care of the Imminently Dying
  8. Ethical and Legal Aspects of Care

How do hospice care and palliative care differ?

Palliative care includes hospice care, the commonly referenced care that focuses on the last six months of a person’s life. Hospice and palliative care organizations are working to raise awareness about the type of care they each encompass to ensure patients and their families have accurate information to use in making educated decisions with regard to their care.

The National Hospice and Palliative Care Organization created a quick reference guide that breaks down the differences and helps patients navigate palliative care versus hospice care. Both are provided toward the end of life, but there are key differences that help distinguish each type of care.

Palliative care is available to anyone with a life-limiting illness such as cancer, liver disease or congestive heart failure. This type of care can be provided at any time with the focus on symptom management and care coordination, with no time limit or life expectancy required. Medical treatment can continue while a patient is under palliative care.

Hospice care is a comprehensive program for patients with a life expectancy of six months or less and should be considered when a terminal diagnosis is present and medical treatment is no longer providing benefit. This type of care can be provided anywhere and services are tailored to meet individual needs.  Volunteers are available to assist with running errands, preparing meals and providing breaks to family members by staying with the patient for periods of time. Hospice care is available 24 hours a day, seven days a week with grief support also made available to families of the patient for at least one year following the patient’s passing.

Discussions regarding palliative and hospice care can occur as soon as a life-limiting diagnosis is received. If you are caring for a loved one with a chronic illness, remember, there is never a wrong time to discuss a plan of action with your health care provider to support their quality of life.

Angela Mulcahy, PhD, RN, CMSRN, CHSE, is a clinical assistant professor at the Texas A&M College of Nursing. Her research interests are student simulation, medical and surgical nursing, end of life care and nursing education.

— Angela Mulcahy, PhD, RN, CMSRN, CHSE

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