November 12, 2010
Dear Mayo Clinic:
What is the difference between palliative care and hospice care?
Both palliative care and hospice care serve people with terminal illnesses. But palliative care usually comes before hospice care and, unlike hospice, palliative care may include therapies aimed at treating the disease.
Palliative care is comprehensive care for people who are dealing with incurable diseases. Typically, palliative care is intended for people who have a life expectancy of one year or less, should the disease run its normal course. The focus of palliative care is on controlling symptoms, managing complications and maintaining quality of life.
The medical services a person receives during palliative care usually include treatment intended to reverse illness or restore health, as well as efforts to relieve suffering and improve quality of life. At the beginning of palliative care, greater focus may center on therapies designed to cure the illness or prolong life. As a person's medical outlook and health status worsen, however, the goal of restoring health becomes less likely. As the underlying disease progresses or the patient has complications, the goals of relieving suffering and providing the best possible quality of life may become the focus of care.
Medical therapies used for palliative care shouldn't be an alternative to, or an abrupt change from, a person's previous course of treatment. Ideally the shift in focus of care is gradual and is negotiated among the patient, family and care providers over time. To help make that happen, when a person with a life-threatening illness chooses palliative care, a palliative care specialist is usually assigned to work with the primary care doctor and a team of other medical professionals to create a comprehensive treatment plan.
The palliative care team may include specialists in pain management, physical medicine and rehabilitation, psychiatry and bereavement, as well as pharmacists, social workers, nurses and other doctors, as needed. In addition to medical care, palliative care plans also address spiritual and psychological concerns, and include ways to help maintain a person's dignity and comfort. Members of a palliative care team can also help coordinate financial and legal assistance, if necessary.
Hospice care involves many of the same issues and concerns as palliative care. But hospice is designed to focus on comfort over cure, and to make the final months and days of life as meaningful as possible. Hospice care is usually an option only after all treatment alternatives have been exhausted and typically is reserved for individuals who are expected to live six months or less. Most people have completed all active treatments, such as chemotherapy or radiation, prior to beginning hospice care.
Whereas palliative care services are usually provided in a medical setting, hospice often takes place in a person's home with a family member as the primary caregiver. Alternatively, hospice care may be available at a hospital, nursing home or in a dedicated hospice facility. Health care team members may include doctors, nurses, home health aides, social workers, hospice volunteers, spiritual counselors — such as chaplains, priests, pastors and lay ministers — and bereavement counselors.
Although they come at different points in the care process, both palliative and hospice care share a commitment to supporting people with terminal illness and their families as they manage and cope with end-of-life issues and decisions. If you or a family member is facing a life-threatening illness, palliative care and hospice care can be valuable resources. Talk to your doctor if you have questions or would like more information about palliative and hospice care.
— Judith Kaur, M.D., Oncology, Mayo Clinic, Rochester, Minn.