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Care Options for Serious Illness: Palliative Care

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While much of advance care planning focuses on what you don't want to happen, it is equally important to consider the positive options. “There is nothing more we can do” is one of those phrases that should be erased from the medical vocabulary.

Something can always be done to keep a person's pain and symptoms under control and to support the emotional and spiritual needs of a person with advanced illness and the family that experiences distress and loss.

Two options that stress holistic management of serious, life-threatening illness are palliative care and hospice. They are different but related. Both suffer from misperceptions that choosing either means giving up, as if serious illness were something that can be cured by will power or yet another last-ditch effort.

Some people do not want to die in full battle mode but are urged on by doctors and family to try one more round of chemotherapy or a drug that is still being tested and has nasty side effects. Hospice and palliative care provide other, more peaceful options.

Both palliative care and hospice are voluntary choices. No one can force you or your parent to accept this type of care if you don't want it.

Palliative care is a relatively new medical subspecialty practiced by specially trained physicians, nurses, physician assistants, social workers, clergy, and others. Most palliative care is delivered by hospital teams, but some outpatient services are available through clinics and home care agencies.

Palliative care offers services that improve how individuals function in everyday life, even as they undergo active treatment for a serious illness. Care focuses on pain relief, symptom control, and improving quality of life. Palliative care can be time-limited or ongoing. The ill person and family members are considered part of the palliative care team.

Palliative care can be provided along with treatments intended to cure. It can be started at any point in an illness. In fact, palliative care specialists urge people to consider palliative care at an early stage because the kinds of treatments offered can make it easier to go through the rigor of a chemotherapy regimen, for example.

Palliative care is covered by most health plans, including Medicare and Medicaid, as a regular medical service. However, there is no special Medicare benefit for palliative care as there is for hospice.

If, in a hospital setting, you feel that more needs to be done to control pain or discomfort, ask for a consultation with the palliative care team or specialist. This request does not mean changing doctors; it is asking for special expertise to deal with the problems.

For more information about palliative care, go to the Center to Advance Palliative Care. The website includes a listing of palliative-care resources that you can search by state and city.

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