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About Palliative Care and End of Life

Naturally, sensitive topics have a tendency toward silence.

Palliative care and end of life, for instance, are difficult to talk about or even think about because of the subject matter. Consequently, health care preferences in relation to a chronic or terminal illness are often left unspoken, causing patients to receive treatments or an extent of care they may not have chosen.

But making and communicating palliative care and end-of-life decisions in advance can enhance quality of life for both patients and their caregivers. Early conversations can take place in more relaxed, comfortable, and familiar settings such as at home and in the primary care doctor’s office, rather than in the Intensive Care Unit or Emergency Care Center, when decisions may have to be made quickly in a time of crisis. With early planning and arrangements, patients can receive adequate management of pain and other symptoms and see that their treatment wishes are honored.

Understanding that palliative care and end-of-life planning enhance quality of life, especially when implemented early, Sturdy Memorial is taking the initiative to improve care for patients and residents of the Hospital’s service area communities.

By breaking the silence.

What is palliative care?
Palliative care provides chronic or terminally ill patients with relief from the pain, symptoms, and stress of their conditions. This specialized medical care “helps patients take control of their illnesses and feel supported throughout the various stages of their diseases,” says Karen Messier, MSN, RN, AOCN, Oncology Program & Clinical Manager. “To encourage early dialogue and initiation of palliative care, doctors at Sturdy invite patients to talk about what would be an acceptable level of pain, how much treatment they want, and what kinds of treatment they would like to have going forward. Patients are guided and empowered to make informed decisions about their care.” Sturdy physicians also refer appropriate patients to palliative care resources in the community.

Who receives palliative care, and when?
Palliative care is an appropriate choice for patients with conditions including: cancer, chronic liver disease, kidney failure, dementia, chronic obstructive pulmonary disease, congestive heart failure, and other diseases known to be incurable. “Palliative care can begin at diagnosis and can either accompany or take the place of aggressive, curative therapy,” says Dr. Steven Frank, a board certified Family Medicine physician. “Hospice care functions on the same principles of comfort and support as palliative care, but takes place in the final months of life.”

What are the benefits of palliative care?
“With palliative care,” says Dr. Steven Bensson, a primary care physician who is board certified in Internal Medicine and Geriatrics, “symptoms associated with chronic or terminal illnesses, such as pain, fatigue, nausea, loss of appetite, or shortness of breath, can be managed. Even if the disease can’t be cured and patients choose to no longer have aggressive treatments, symptoms can be treated. With diminished or eradicated pain as well as restored energy, appetite, and breathing, patients can live more comfortably.” Palliative care can make patients feel better physically as well as emotionally and spiritually.

Why is palliative care important?
Patients facing serious illness need compassionate care, relief from distress and pain, support throughout their disease process, and reliable information and access to help. Without palliative care, patients might experience inadequate management of pain and other symptoms. Having the palliative care conversation early on provides sufficient time to arrange support services, understand the disease course, and truly enhance quality of life. It also ensures care preferences are honored.

How do I get palliative care for myself or a loved one?
It is important that palliative care be addressed openly and well before end of life becomes imminent. Patients should talk about palliative care and treatment preferences with their loved ones and primary care physician early on and express their wishes should they become ill with a chronic or terminal illness. Discussion should cover the types and extent of care patients prefer.

Why is end-of-life planning important?
Choices regarding end-of-life care are difficult to make, but are much more stressful when left up to loved ones in a crisis situation. Without thorough end-of-life planning, disagreement among loved ones over patients’ medical care could create a dilemma. “Heroic measures” such as respirators, feeding tubes, and other forms of life-sustaining treatment might be administered when in fact these may not have been patients’ preferences. This can also create added stress and friction or guilt among family members.

How can I or a loved one plan for end of life?
To alleviate this burden from others should patients ever become seriously ill and incapable of making their own health-care choices, it is recommended that patients express and document their end-of-life wishes by completing a health care proxy form and designating a health care agent to make medical decisions only when capacity for decision-making is lost. Documenting wishes clarifies treatment instructions and alternatives.

Palliative care and end-of-life planning resources
Need a “conversation starter” to help you speak with loved ones and your physician about palliative care and end-of-life planning? The Conversation Starter Kit, provided by The Conversation Project, is a valuable resource to help patients broach the sensitive topic and begin planning care. Call Public Relations a 508-236-8020 and request a mailed copy, or download one instantly by clicking here.

Looking to fill out a health care proxy form? Visit the Massachusetts Medical Society website by clicking here. The Case Management Department at Sturdy is also a resource for documents and guidance, and can be reached at 508-236-7680.