Palliative Care

Palliative care is the medical approach in caring for patients with serious illnesses, focusing on the relief of pain and stress symptoms. The goal of palliative care is to improve the quality of life for the patient and his or her family. Many physicians use the term "palliative care" in the sense that therapies provide relief, but no cure, as in the case of late-stage cancer, for example.

Since 2006, palliative care has been a board-certified sub-specialty of internal medicine, utilizing a multidisciplinary approach in consultation with nurses, pharmacists, social workers, psychologists, and even chaplains in order to form a comprehensive care plan. Most medications employed in palliative care are designed to alleviate symptoms without having any effect on the course of the disease, such as treating nausea, or using morphine to control pain.

Palliative care must be differentiated from hospice care. In the United States, while both are designed to provide relief from symptoms and pain, the difference between the two are as follows:

1. Palliative care can be employed for numerous illnesses, including chronic diseases that are not immediately fatal.
2. Hospice care is employed in cases where death is imminent or inevitable.

One of the major challenges for physicians providing palliative care often comes from family members of patients. Many doctors encounter hostility and resistance from family members, and are often accused of performing euthanasia. This negativity comes despite the physician's desire to reduce suffering.

According to research by Paper Masters, 52 million individuals die each year, many of whose lives end with unrelieved physical, psychological, social, or spiritual suffering. While many afflicted with terminal diseases may feel a sense of hopelessness, care practices do exist that restore hope in the face of death and offer support in all facets of care. Palliative care is a person-oriented process that provides relief from pain and other types of suffering. Although not intended to treat or cure the disease itself, this type of care provides support to patients and their families to enable ill individuals to live their remaining lives to the fullest and to assist loved ones in coping with the patient's illness and their own feelings.

No one specific model of palliative care works best for every individual; thus, the chosen model must reflect the unique needs and circumstances of each person. Several different models of palliative care exist. In-patient palliative care units exist in hospitals or free-standing facilities and provide symptom management, terminal care, or relief for caregivers.Community services may provide support for doctors or other professionals working with patients or provide health services directly to patients within their own homes. Day Units are often part of a hospital setting and provide support and rehabilitation during the daytime for individuals also receiving care at home. Hospital palliative care teams consist of doctors, specialized nurses, and social workers that work together to provide support and education for family members and staff. These types of support may range in magnitude from small gestures to show empathy to actually assisting in the daily care of a dying individual.

Kesselman (2004) created an additional model of palliative care specific to social workers and comprised of three components.

1. Continuous Assessment of the patient's physical, psychological, and social status is necessary to develop effective plans for service. This assessment should include levels of pain experienced by the patient as well as the specific needs of the primary caregiver.
2. The second component, Case Management, requires the social worker to act as a liaison between the patient and healthcare team to ensure that appropriate services are received, proper medication and medical devices are obtained, and social isolation is minimized.
3. The final component, Advanced Care Planning, occurs as the patient is nearing the end of his or her life and involves the finalization of the advanced directives of a living will, a health care proxy, and durable power of attorney.
   

Within the confines of these various models, social workers should perform the steps necessary to comfort the patient, even in situations when death is not imminent. In fact, many times death is a rather ambiguous concept in which individuals are at risk for death but a timeframe by which it may occur is unknown. For example, individuals may suffer for some time with chronic illnesses such as heart disease or chronic obstructive pulmonary disease. For these individuals death may come at an unpredictable moment and even occur due to secondary causes. Social workers can assist individuals in these situations by providing explicit and comprehensive medical information and then putting this information into the context of an individual's life. Thus, the patient can make appropriate decisions concerning other areas of life such as prioritizing resources, time, money, and energy. The social worker can also help to normalize feelings experienced by the patient through empathetic listening. Finally, advanced care planning should occur in such a way as to reflect that death may not be imminent and the day or week of death remains unknown.

A prominent role of the social worker providing palliative care is that of spiritual care. Bartlow (2000) views the most important component of spiritual care - the soul - as being individual, eternal, the legacy we leave behind at the end of our lives on Earth, and a universal force that binds all people together as one. Caring for the soul by addressing spiritual needs helps individuals find hope and peace in suffering. The social worker can provide care in this area by listening to the hopes and dreams of patients, loved ones, and caregivers. It is also important to provide opportunities to pray, meditate, or participate in ritual activities specific to the patient's religious beliefs. The patient may also need assistance in finding ways to make peace or receive forgiveness from his or her Creator or others. Social workers can help meet these needs by involving providing referrals to counseling and bereavement programs as well as religious leaders such as chaplains.

A patient's religion can have a profound impact on his or her attitudes towards end-of-life care. For example, different religions hold different views of organ donation, blood transfusions, resuscitation, and ritual practices associated with death. One study indicated that HIV-infected individuals who perceived the disease as a punishment from God were less likely to desire resuscitation and more afraid of death. Additionally, those who prayed regularly and felt as though they had a relationship with God were more likely to construct a living will and be less afraid of death.