Palliative Care: Pain and Symptom Management at the End of Life
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Palliative care focuses on the prevention and relief of pain and suffering by careful management of symptoms. Palliative care is the type of care offered to people who are terminally ill and pays attention to the physical, emotional, spiritual and practical needs of patients and those caring for them. Palliative care regards dying as a normal process; it neither hastens nor postpones death, but provides relief from pain and other distressing symptoms. It helps contribute to what one might consider a "good" death, that is a death free from avoidable suffering and stress for patients and their caregivers.
Hospice (or hospice care) is the setting where people who are terminally ill receive palliative care. Hospice care can take place either in your home or in a home-like facility. The goals of hospice care are to control pain, provide high-quality palliative care, and preserve the highest possible quality of life for as long as life remains.
Discussing palliative and hospice care as well as other end of life issues is never easy. Most people have not learned how to talk realistically and comfortably about dying. American society is just starting to learn that the dying phase can still be an important, valuable time in a person's life. The result is fear and misinformation that leads us to believe that pain and misery at death is unavoidable. Research demonstrates that it is possible to reduce suffering at the end of life. Many patients and families simply do not know that there are options to relieve end of life pain and suffering and what those options are. Being aware of services such as hospice and palliative care, and asking for these kinds of services may help patients and caregivers. To read more about end of life care, click here.
Here are some things to remember:
A person with cancer and those who care about them may be at different "places" in accepting or understanding a prognosis that is terminal. This can make talking about these issues difficult and complicate decision making. A social worker or other health care professional can help sort through the different issues, emotions and choices that patients and caregivers may have.
If there is no further treatment focusing on a cure, people often think that that there is "nothing left that can be done." On the contrary, much can be done for someone who is terminally ill. The type of care given just has a different focus, and there are many options.
Many end of life concerns come from people fearing either overtreatment (too much aggressive care) or abandonment (getting no care). As difficult as it is to talk about, it is best to acknowledge these fears and work with the health care team to find a balance that is acceptable.
Many times patients, families or caregivers think it is "too soon" to start hospice care and wait until death is very near. Bringing hospice professionals in at the last minute makes it difficult for them to provide the care that is needed. A better approach is to arrange preliminary home meetings or hospice visits early on and obtain counseling from hospice or other health professionals who can provide useful suggestions on arranging care. Building a support network before a crisis occurs will help ease the stress of the situation.
This section provides a limited introduction to an area of pain management and symptom control that is important for you to know about. We hope that review of this section will help open the door for family discussion of these complex but significant issues.