What is Palliative Care?

Palliative care is a specialized system of care for people with serious chronic diseases. Instead of focusing on curing the disease, palliative care focuses on managing symptoms of the disease and any side effects that may occur during treatment. Palliative care is a patient-centered approach to healthcare—the focus is on improving quality of life for patients and their caregivers.

What Does Palliative Care Involve?

Palliative care specifically addresses:

  • Physical symptoms such as pain, fatigue, nausea, vomiting, constipation, loss of appetite, sleeplessness, and shortness of breath
  • Psychological symptoms such as stress and anxiety, grief, hopelessness, fear, agitation, and depression
  • Social difficulties such as isolation, loneliness, anger, and guilt
  • Financial issues such as paying for treatment, finding suitable housing, and arranging transportation
  • Spiritual issues, whether they are part of a formal religious tradition or not

What is a Palliative Care Doctor?

A palliative care doctor is a physician who has specific training to manage the issues that arise during the course of a serious, chronic illness. In most cases, a palliative care doctor has completed training in internal medicine or psychiatry and then pursues a fellowship or other post-residency training to become a palliative care doctor.

Other medical providers may choose to become palliative care specialists. Pharmacists can choose to specialize in pain management and palliative care. Likewise, some advanced nursing and social work programs have specific palliative care tracks.

What is a Palliative Care Team?

Palliative care is usually practiced as a team. Your palliative care doctor will assemble a group of providers that can meet the various needs you may have. Depending on your particular needs, your palliative care team may include:

  • Primary care physician
  • Physician specialists
  • Oncologist
  • Cardiologist
  • Pain management
  • Psychiatrist
  • Physical therapist
  • Occupational therapist
  • Speech therapist
  • Respiratory therapist
  • Nutritionist/dietician
  • Nurses
  • Pharmacist
  • Social workers
  • Care coordinator
  • Spiritual counselors
  • Home health aides
  • Volunteers
  • Family and friends

A palliative doctor will serve as the hub of this palliative care team; however, the patient is always at the center of care.

How is a palliative care doctor different from my regular doctor?

Of course, your regular doctor wants to help alleviate symptoms, but that is not usually the primary goal of treatment. Your regular doctor wants to treat and cure your disease. A palliative care doctor leaves the "curing" to your other doctors. A palliative care doctor, instead, helps you to be as comfortable, vital, pain-free, and mentally and emotionally healthy as you can be. The goal of the palliative care doctor is to help you have the highest possible quality of life.

How is Palliative Care Different from Hospice Care?

This is such an important question, and one that even many doctors don’t fully understand. The biggest difference between hospice and palliative care is that hospice is specifically for people who are expected to live less than six months. Palliative care, on the other hand, is for any person with a serious, chronic illness regardless of how long they are expected to live. People receive palliative care while in hospice, but not all patients receiving palliative care are in hospice.

Does Being in Palliative Care Mean I Have to Stop Curative Treatments?

No. When people enter hospice, they agree to no longer request curative treatments, that is, treatments that are meant to cure or stop the disease. They receive supportive care to relieve pain and other issues. Hospice is for people who are expected to live six months or less because of their disease is "terminal". When palliative care is provided to someone who is not in hospice, it is done right alongside regular, curative treatments.

What is Palliative Care for Cancer?

Palliative care emerged as a separate medical specialty largely to help people with cancer. In many cases, the treatments for cancer such as chemotherapy and radiation therapy can be as difficult to endure as the cancer itself. Palliative care was an acknowledgement that people with cancer needed something beyond chemotherapy and radiation. Someone needed to help people maintain body weight, fight nausea, improve poor appetite, and relieve pain. Cancer doctors concentrated on killing cancer cells, while palliative specialists concentrated on helping people stay as healthy and happy as possible.

As more and more people began to develop chronic illnesses, palliative care expanded to include people struggling with other diseases such as congestive heart failure, chronic kidney disease, and chronic neurological disorders.

Am I Eligible for Palliative Care?

If you have a serious, chronic illness, you are eligible for palliative care. People of any age are eligible for palliative care, from newborns to the elderly. It does not matter if the disease is curable or "terminal" as long as the disease or its treatment causes pain, nausea, or other reasonable prolonged physical suffering. The best way to find out if you are eligible for palliative care is to talk with a palliative care specialist.

Chronic Diseases Managed by Palliative Care Specialists

  • ALS
  • Alzheimer’s Disease
  • Cancer caused by solid tumors
  • Cancers of the blood
  • Congestive Heart Failure
  • COPD
  • Dementia
  • Epilepsy
  • Fibromyalgia and related conditions
  • HIV/AIDS
  • Huntington’s Disease
  • Kidney Disease
  • Liver Disease
  • Lung Fibrosis
  • Multiple Myeloma
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Rheumatoid Arthritis
  • Sickle Cell Anemia
  • Stroke

Does Medicare Cover Palliative Care?

Medicare Part B will cover most palliative care costs; however, these may be restricted by the primary disease. For example, cancer palliative care is usually covered, but palliative care for some diseases like fibromyalgia may not be. Medicaid coverage for palliative care is usually not as broad as Medicare coverage, and the level of Medicaid coverage tends to vary by state.

Importantly, Medicare and Medicaid do not officially use the term "palliative care" to cover what are, essentially, palliative care services. The distinction between hospice and palliative care is very important when it comes to Medicare and insurance coverage. Your palliative care specialist can explain this in detail.

Where Do I Receive Palliative Care?

Palliative care is not provided at any single place—it is provided wherever you are. Your palliative care team can provide treatment while you are in the hospital, an assisted living facility, an extended care facility (nursing home), during hospice, or at your own home.

Contributing Authors

Kelli Wilson, RN

Kelli is a Registered Nurse with over 19 years of experience in long term care nursing homes. Though the years she’s worked up to Assistant Director, and Director of Nursing. Kelli has been involved in admissions, discharges, and arranging home care. She’s also familiar with Medicare/Medicaid requirements and how to preform pre-authorizations.

Latest posts by Kelli Wilson, RN (see all)

    James Conte, RN, BS Nursing, BS Pharmacology

    James is a Registered Nurse with a BS in Nursing, a BS in Pharmacology, and a BS in Electrical Engineering. He brings with him many years of experience working in Long Term Care facilities, and as a Registered Nurse in an Intensive Care Unit. His familiarity with nursing and emergency care provides an invaluable perspective on managed care.

    Latest posts by James Conte, RN, BS Nursing, BS Pharmacology (see all)

      Miranda Booher, RN, ACLS Certified, BLS Certified, Tx Certified

      Miranda’s strongest area of expertise is nursing. She has worked as a registered nurse for over 6 years with 4 years experience on a pediatrics and orthopedic surgical unit and 2 years as a travel nurse, working in critical care and healthcare informatics.

      Latest posts by Miranda Booher, RN, ACLS Certified, BLS Certified, Tx Certified (see all)

        Carolyn Falconer-Horne, Ph.D. Candidate

        Currently working towards her Ph.D., Carolyn is a licensed and certified speech-language pathologist with over 15 years of experience working in rehab hospitals, long term care facilities, and skilled nursing facilities.

        Latest posts by Carolyn Falconer-Horne, Ph.D. Candidate (see all)

          Last modified: June 9, 2017