Chapter 53 - Introduction to Palliative Care

Summary

Palliative care, an approach to care that improves the quality of life of patients and families, has rapidly become the standard of care for patients with serious illness in recent decades. A large body of quality evidence supports interprofessional palliative care delivery as a means to improve symptom control, mood, and communication and result in less aggressive treatment at the end of life. One large component of this palliative care is skilled, structured communications; meeting with patient, family, and other medical specialists involved with complex patient care. Additionally, focus on pain and symptom control requires a nuanced approach, especially in the older adult at higher risk of drug-related adverse events. Increasingly important to understand is the complexity in use and prescription of opioids. They have both intended and unintended consequences of use; both effective pain control in serious illness and diversion or misuse. Pain, nausea, vomiting, dyspnea, and delirium increase in prevalence as patients burden of illness increases. Pharmacotherapy and non-medication-based interventions are both often effective as patients approach the end of life. Hospice remains the gold standard of care for dying patients, but because many people still die in hospital settings, it is critical that clinicians are knowledgeable in providing end-of-life care.