Department of Medicine

University of Pittsburgh

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About Palliative Care

What Is the Goal of Palliative Care?

"The goal of palliative care is to maximize quality of life for patients living with a serious or life-threatening illness. A patient can benefit from palliative care at any stage of chronic illness, from the time the disease is diagnosed to its final stages. It takes an entire team, including a doctor, nurse, pharmacist, psychologist, social worker, and chaplain, to provide palliative care. One important aspect of care is controlling the patient's bothersome physical symptoms, such as pain, shortness of breath, nausea, and fatigue. Careful use of medications often achieves this goal. Another aspect is helping the patient and his or her family plan for the future and establish goals for medical care."

Linda King, MD, University of Pittsburgh School of Medicine

Why Does Palliative Care Need to Be "Enhanced"?

Although caring for and comforting people who are sick and suffering is an impulse as old as humanity, the professional approach known as "palliative care" is relatively new. It has developed over the past 30 years in response to the changes wrought by modern medical advances and their effect on how people experience illness, dying, and death. Before the 1900s, most people died relatively quickly from acute infectious diseases or accidents. Now, drugs, machines, and procedures are frequently able to keep people alive for a long time with conditions that would have previously been rapidly fatal, such as cancer and end-stage heart, liver, lung, kidney, and neurologic diseases. As a result, most people in the United States die from long-term chronic conditions that are characterized by a prolonged period of distressing symptoms and progressive loss of function. Palliative care works to alleviate these symptoms and maintain the best possible quality of life for patients whose lives technology has extended and for the patients' family members.

Public opinion polls, medical organizations, and research institutes have clearly documented that large numbers of seriously ill and dying patients and their families suffer needlessly because of gaps in the health care system. These problems are especially persistent in Pennsylvania, which has one of the highest proportions of elderly individuals in the United States. Those who die in Pittsburgh are a great deal more likely than others across the rest of the state and the country to experience hospitalization in the last 6 months of life and are at higher risk for a hospitalization to include an admission to an intensive care unit. While some hospitalizations lead to meaningful recoveries or welcome improvements in health, all too often patients bear physical, emotional, and financial burdens of unhelpful and unwanted medical care near the end of their lives. In caring for critically ill patients, we urgently need new approaches that promote comfort, dignity, continuity of care, communication, and family support.

Research indicates that seriously ill patients and their families want and need what palliative care offers: relief from symptom distress; control over what happens to them; avoidance of prolongation of the dying process; help with the burden on family caregivers; and the opportunity to strengthen important relationships. Unfortunately, their desires and needs are not always met:

  • Studies have shown that 40%–50% of nursing home residents in the United States live in persistent pain. They have also shown that 50% of hospitalized dying people have moderate to severe pain more than half the time before they die.
  • Although Gallup Polls consistently show that 80%–90% of us would prefer to die at home, the vast majority die in institutions, many receiving unwanted and burdensome care.
  • For patients who die at home, the financial, physical, and emotional burdens of caregiving fall heavily on the members of isolated nuclear families and predominantly on women.

Despite recent gains, palliative care and hospice care reach only a small fraction of patients who could benefit from them. Many patients and families are unaware of the possibilities for compassionate, reliable, effective care during the stressful phases of critical illness, death, and bereavement. Only a minority of health professionals have mastered the knowledge and skills required for excellent end-of-life care. Because physicians are trained to cure disease, they are often uncomfortable in the presence of patients whose diseases they cannot cure or patients who have decided to forgo aggressive curative treatments. As a result, honest and open communication between doctor and patient—communication that is so necessary for realistic planning in the face of a grave prognosis—often fails to occur.

Why do people with serious illnesses and their families continue to suffer in a world where we have the resources to prevent needless suffering? According to the Institute of Medicine and a report by the National Cancer Policy Board, for palliative care to fulfill its promise, our society must make significant progress on three fronts:

  • Research into the most effective treatments for physical, psychosocial, and spiritual suffering.
  • Education of health professionals in state-of-the-art pain and symptom management, communication, and other palliative care skills.
  • Community engagement and education to raise people's awareness of their options for high-quality palliative care so they can demand it for themselves and their loved ones.

These are the core elements of the mission of the Institute to Enhance Palliative Care.