What Does it Mean When Your Patient is Palliative?

Alice Blackmore, MSN, RN

What do you think when the doctor says that your patient is palliative? If the first word that comes to mind is dying, then you are like many other healthcare professionals.

However, the patient you were told is palliative may not be imminently dying. They might have weeks, months, or even years left before they die. They may even outlive you.

In fact, labeling a patient as palliative is not the correct usage of medical terminology.

Palliative

It might help if you consider the definition of palliative. Palliative can be used as a noun or an adjective. According to the Merriam-Webster Medical Dictionary, the noun palliative means something, such as a treatment or drug, that relieves uncomfortable symptoms caused by a disease process. It does not cure the patient. When palliative is used as an adjective, it means that the drug or treatment is providing relief but not offering a cure. So, to clarify, palliative as a noun is a drug or a treatment, and palliative as an adjective means offering relief. So, no patient should be labeled as palliative. The word palliative does not even mean dying.

Palliative Care

Is it possible that healthcare providers are confusing the word palliative with palliative care? The majority of nurses and other health care professionals are familiar with the term palliative care. Being consulted to palliative care brings a sense of dread to most patients, but palliative care should be a positive term. It is a holistic approach by a multidisciplinary team to provide physical, emotional, and spiritual care. Palliative care is offered to patients with terminal illnesses that will lead to death. But it is also offered to patients with serious chronic illnesses, such as heart disease, to cancer patients who have a chance of surviving their malignancy, and to patients with dementia. Patients in palliative care may receive curative and symptom management treatments in order to achieve a sense of wellness and quality of life.

Palliation

But maybe the term palliative care is not viewed as a positive expression because it is equated with palliation. So, what is palliation? Palliation comes from the verb to palliate. The Merriam-Webster Medical Dictionary aptly describes it as reducing the "violence" of disease. In healthcare, palliation occurs when the patient is actively dying. Nursing care and medications to relieve pain and suffering are given, along with emotional and spiritual support to comfort the patient and their family.

Hospice

Another word jumps in. Hospice. How does hospice differ from palliative care and palliation? Hospice provides care to patients who are approaching the final end of their disease process and usually begins when the patient has six months or less to live. The primary goal of hospice care is to provide symptom management and compassionate support. There is no effort made to cure the disease. Hospice can be a building where a patient goes to die, but hospice can also be brought to the dying person in their own home. Patients can still receive palliative care symptom management in hospice, but the palliative care process should have been initiated when the person was diagnosed months or even years before. Hospice supports the patient in their final days and hours and culminates in palliation and death.

What To Do When Someone is Labelled Palliative?

So what does the doctor mean when they say that someone is palliative? This is actually an important question. You need to ask the physician for more information. Does the physician mean that the patient is imminently dying? What are the goals of care? Is the patient to be consulted to palliative care? Or does this person have less than six months less to live and needs to be consulted for hospice care and receive palliation orders?

As healthcare providers, we need to use these words correctly or mistakes will be made. If someone has been labeled palliative and you think they are imminently dying, it will affect the care you give and the orders you ask for.

Palliative. Palliative Care. Palliate. Palliation. It doesn't help that these words all sound the same. As healthcare workers, we often slide into using medical terminology incorrectly because they are understood by our coworkers. These words take on meanings that we, as health care providers, have assigned them, meanings that don't match the actual definition.

So, if the physician tells you that your patient is palliative, do not assume that your patient is dying. Instead, ask questions. This will provide clarification of your patient's status and also present an opportunity for healthy discussion surrounding the meaning of these confusing words and their correct usage.

References/Resources

American Cancer Society: What is Hospice Care?

Mayo Clinic: Palliative Care

Medline: Palliative Care

Merriam-Webster Dictionary: Palliative

Merriam-Webster Dictionary: Palliate