Palliative care has been described as: A comprehensive management of patients' physical, psychological, social, spiritual, and existential needs that enhances comfort and improves the quality of an individual’s life during the last phase of life (Last Acts, 1997).

No specific therapy is excluded from palliative care. The test of palliative care lies in the goals set by the patient, physician(s), primary caregiver, and the hospice team with the expected outcome of relief from distressing symptoms, the easing of pain, and/or enhancing the quality of life.

The decision to intervene with active palliative care is based on an ability to meet stated goals rather than affect the underlying disease. An individual’s needs must continue to be assessed and all treatment options explored and evaluated in the context of the individual’s values and symptoms. The individual’s choices and decisions regarding care are paramount and must be followed.

Kaiser Permanente’s Palliative Care was developed as a means of achieving balance in end-of-life care and helping seriously ill patients find peace and dignity between the extremes of too little care and too much. The program was initiated as an alternative to Kaiser Permanente's hospice program, which like other hospice programs across the country, was being underused.

Many Kaiser Permanente members eligible for hospice care either refused services or were never referred to the program for a variety of reasons, including physician uncertainty in determining life expectancy, patient unwillingness to forego curative care (and hope), and other negative connotations of the word "hospice." As a result, patients often died in acute-care hospital beds or intensive care units, sometimes following bouts of medically futile care.

Frustrated and disturbed by these trends, we established the Palliative Care (PC) program, which offers improved care to dying patients and their families. Modeled after Kaiser Permanente's hospice program in that it offers pain management and other comfort care in the patient's home, the PC Program features three important modifications, all of them intended to promote timely referrals to the program:

• Physicians are not required to give a six-month prognosis. Recognizing that it is often difficult to estimate life expectancy, we’ve changed referral guidelines. Physicians are asked to refer any patient if they "would not be surprised if this patient died in the next year." Thus, as a general rule, palliative care patients are accepted into the program with a prognosis of 12 months or less to live.

• While the Palliative Care Program emphasizes much improved pain control and other symptom management, patients do not have to forego curative care, as they do in hospice programs.

• Patients are assigned a palliative care physician who coordinates care from a variety of health care providers, including specialists and the patients' primary care physician, thus preventing the service fragmentation that often occurs in health care systems.

In addition to these design improvements, the program features five-core components, each of which contributes to enhanced quality of care and patient quality of life. These core components are:

• An interdisciplinary team approach, focusing on the patient and family, with care provided by a core team consisting of a physician, nurse, and social worker, all with experience in pain control, other symptom management, and psychosocial intervention.

• Home visits by all team members, including physicians, to provide medical care, support, and education as needed by patients and their caregivers.

• Ongoing care management to fill gaps in care and ensure that the patient's medical, social, and spiritual needs are being met.

• Telephone support via a toll-free number and after-hours home visits available 24 hours a day, seven days a week as needed by the patient.

• Advanced care planning that empowers patients and their families to make informed decisions and choices about end-of-life care.
  

http://www.growthhouse.org/palliat.html
Growth House, Inc., provides this portal as an international gateway to resources for life-threatening illness and end of life care. Their primary mission is to improve the quality of compassionate care for people who are dying through public education and global professional collaboration. Their search engine provides access to the Internet's most comprehensive collection of reviewed resources for end-of-life care.

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;106/2/351
AAP Policy brings together a constellation of policy documents from the American Academy of Pediatrics. Policy Statements, Clinical Reports, Clinical Practice Guidelines, Technical Reports, and Parent Pages can now be found in one convenient location.

http://www.capc.org/
The Center to Advance Palliative Care (CAPC) is dedicated to increasing the availability of quality palliative care services in hospitals and other health care settings for people with life-threatening illnesses, their families, and caregivers.

back to Benefits Advocacy