Palliative Care Continuum
Palliative care is a continuum of care that can span from the point of diagnosis with a serious illness to death. As illustrated by the diagram below, palliative care can be provided in coordination with disease-directed care, such as chemotherapy and radiation for the patient with cancer for whom cure is the primary focus. In fact, there is a growing body of evidence that indicates that many patients benefit from a combination of both palliative and curative treatment in cancer care, even prolonging life in some instances.
Hospice is the Medicare defined benefit that provides palliative care for persons who have a life expectancy of less than six months. Hospice is for the person for whom the focus of care has changed from disease directed or curative care to care that is focused solely on comfort. It is a rich interdisciplinary benefit that can be provided in the home or in a facility based on patient/caregiver preference.
Medicare has established distinct clinical criteria to determine if a person is eligible for Hospice, and two physicians must agree that a person meets these clinical criteria based on their clinical judgment. The patient/caregivers must agree to accept the Hospice benefit. See End of Life Care for more information about care of the dying patient and their family.
Additional Resources
Guidelines
Helpful Web Sites
- American Academy of Hospice and Palliative Medicine
- Hospice and Palliative Nursing Association
- National Consensus Project
- National Hospice and Palliative Care Organization
- World Health Organization
References
- Murray, S. A., Kendall, M., Boyd, K., and Sheikh, A. “Illness Trajectory and Palliative Care.” British Medical Journal 330 no. 7498 (2005): 1007-1011. doi: 10.1136/bmj.330.7498.1007.
- Temel, J.S., Greer, J.A., Muzikansky, A., Gallagher, E.R., Admane, S., Jackson, V.A., Dahlin, M.A., Blinderman, C.D., Jacobsen, J., Pirl, W.F., Billings, J.A., and Lynch, T.J. “Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer.” New England Journal of Medicine 363 no. 8 (2010): 733-742.