PALLIATIVE CARE & HOSPICE CARE SERVICES

Palliative care: It should begin as soon as a cancer or other chronic life-limiting illness is diagnosed. Palliative care is an approach that improves the quality of life of patients (including adults and children) and their families who are facing problems associated with a life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial, or spiritual. It offers a care process that goes beyond the physical symptoms. It uses a team approach to address suffering and support the patients and their families, starting with the diagnosis, treatment phase, hospice care, end-of-life care, and providing bereavement counselling. Palliative care is explicitly recognized under the human right to health and is provided via a patient-centric approach. It is now an integral part of the health services system under global standards.

Hospice care: This term is used when the disease, such as advanced cancer, gets to a point when the treatment can no longer cure or control it. Hospice care denotes that the patient is expected to live approximately 6 months or less if illness runs the usual course. Goals of care here shift from cure towards care, control, and maintaining quality of life. When the cure to serious illness is not possible, or the patient chooses to not undergo disease directed treatments, it is time to label them as hospice care and counsel them to prepare for the next phase of life i.e, end of life care.

End of life care (EOLC): It refers to the health care process that is provided during the last few hours, days or months of life. It encompasses care and support for the patient’s mental and emotional needs, physical comfort, spiritual needs and practical tasks.

THE GRAPH BELOW SHOWS THE PLACEMENT AND RELEVANCE OF THESE COMMON TERMS DURING THE TRAJECTORY OF CANCER OR A CHRONIC LIFE-LIMITING ILLNESS.

Point A: The period of diagnosis (early palliative care)—when disease-directed therapy is to begin and the counselling is done by palliative care team experts.

Point B: Transition from curative to palliative intent of treatment (timely palliative care)—where the symptom burden, especially in the form of severe pain, psychological difficulties, unanswered questions regarding the future and the need for prognostication, etc., are quite high.

Point C: Transition from palliative intent of treatment towards hospice care or end-of-life care (preparatory palliative care)—where the role of the palliative care team is at its peak. It entails multiple lines of discussion regarding the construction of the current and future care plan, putting the anticipated events into words, planning to complete some unfinished tasks, explaining advanced directives as well as the doctrine of double effect, and preparing for a dignified end-of-life care.