But I Thought Hospice and Palliative Care Were the Same Thing?

Hospice and Palliative Care are often confused with one another. This article will explain how they are similar, how they are different and how to help your patient decide which option is best

But I Thought Hospice and Palliative Care Were the Same Thing?

It is not unusual for hospice and palliative services to be confused with one another. When a patient and their family are in the situation of deciding between the two, they are already likely in a place of stress and anxiety and it’s important to provide them with accurate information. Many people view hospice and palliative care as “giving up” and can shut down when the subject is broached. We can change that conversation by explaining how these services work to provide dignity and quality to patients’ lives.

Hospice

The American Cancer Society defines hospice care as:

“Hospice care is a special kind of care that focuses on the quality of life for people and their caregivers who are experiencing an advanced, life-limiting illness. Hospice care provides compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible”

Hospice does not hasten or postpone death, but rather provides support to patients and caregivers until death naturally occurs. Usually, patients are admitted to hospice when they are estimated to have 6 months or less to live, but it is possible to be on hospice services for much longer than that. The goal of hospice care is to ensure quality of life during the dying process. Hospice care teams can include nurses, aides, social workers, chaplains, therapists (physical, music, art, etc), physicians and/or mid-level providers. Support comes in the form of medications for symptom management, medical equipment such as hospital beds and wheelchairs, and even bereavement and respite services for caregivers. Most hospice services are provided in the home, but patients can also have hospice care in the hospital setting and some states have hospice facilities where patients can stay for the around the clock care.

Palliative Care

The National Cancer Institute defines palliative care as:

“Palliative care is care meant to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer.”

The core difference between palliative and hospice care is that patients receiving palliative care may continue to receive active treatment for their disease. Palliative care can begin at any stage of the disease process, whereas hospice is initiated towards end of life and is aimed at comfort care, not curative care. Palliative care teams are made up of providers with specialized training and are often multi-disciplinary in nature. The goal of palliative care is symptom management as well as patient and caregiver support and education on disease process and goals of care. The palliative team will work with the patient’s other providers to treat the patient and their overall well-being, not just their disease process. Palliative care teams can help facilitate communication with other providers, assist patients and caregivers with finding resources for financial/legal concerns, aid with emotional support and much more.

It is not unusual for hospice and palliative teams to work closely with each other, and both can be involved in care of the same patient. Often healthcare workers shy away from bringing up the topic of hospice or palliative care because it can be a very sensitive subject. Knowing the goals of each service and how they can be beneficial to both the patient and their caregivers can help keep the conversation open and positive. Being a patient advocate is a large part of being a nurse and it is our job to educate patients and their families on their available options so they may decide on the best plan of care.

References:

  1. What Is Hospice Care? (cancer.org)
  2. Palliative Care in Cancer - National Cancer Institute

 

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Rebecca D Cook

About Rebecca D Cook

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Specializes in Occupational Health Nursing.

I thought so too when I was in nursing school.

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Specializes in retired LTC.

How are those services paid for? Might be a major deterent.

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Specializes in Mental Health, Gerontology, Palliative.

Good article, you may want to elaborate that this is an american perspective.

I work in hospice, we have people admitted for symptom management or end of life care. It's very unusual for people to stay longer than 10 days. If people are needing long term care they will go to an inpatient care facility

Palliative care is community based and is limited to people with an illness and life expectancy of less than 6 months

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Specializes in MS,Cardiac,Post-Trauma Surgical,Ortho,PACU/Preop.

Clarifying the significant differences between hospice and palliative care is essential in educating patients and caregivers. In addition, highlighting the benefits and indications for each care may encourage understanding of the information being sought.

I've witnessed how families feel distraught when the idea of these care services is discussed, and they tend to be more hesitant to make the decision. It could be unfamiliarity or health literacy limitations. So, educating the patient and their caregivers may help provide information concerning what care services are appropriate to meet the care needs of the patient/family. 

Thanks for showing how you can help your patient and families navigate their health care needs as a nurse. 

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Thank you; very helpful article.

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Specializes in Intensive Care, Paediatrics, Long-term care.

This is a much needed topic to discuss. Patients and their families cringe when they hear the words "Palliative Care." Yet, it is palliative care interventions and support that will improve their quality of life and feeling of wellness in their illness. Good article!!

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Specializes in Palliative Care and Case Managment.

For Amolucia,

CMS is and has been making strides for the coverage of palliative services not related to hospice. Check out CMS Innovations:

Palliative Care Projects: Synthesis of Evaluation Results 2012-2021 (cms.gov)

The real challenge, at this time, is getting Palliative care services in your home. In my local area there is one Palliative Care Agency who does home visits. Otherwise, the local hospitals only have outpatient services or in hospital consults focusing on the most critically ill with high risk for mortality, cancer or CHF. Accreditation of cancer centers and AHA guidelines dictate incorporating Palliative principles into their programs driving the programs there. 

In my opinion the best way to incorporate Palliative Care into practice is just that, incorporate those concepts into everyday practice! Doing so will begin to help folks understand when they need more formalized services. The most simplistic way is to incorporate terminology (Since we can't change what we call it). "Here is a pillow, ice and Tylenol to palliate your knee injury. Taking care of these symptoms will help you to feel better. Continue them at home."

With repetition and normalization our culture can change. 

 

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