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Palliative Care: Making End of Life Decisions

Published August 27, 2013

As members of the baby-boom generation enter their retirement years, awareness is growing of the importance of palliative care for older patients with chronic illnesses, and how planning can clarify difficult end-of-life decisions.

Palliative care is a branch of medicine that focuses on providing relief from the pain and stress of chronic illness. Doctors may be primary care physicians with a specialty in palliative care and may work together with nurses and social workers to improve patients’ quality of life.

A study published in the New England Journal of Medicine found that palliative care could not only improve the quality of life for patients, but could result in them living longer. Some evidence indicates that palliative care early on can reduce the amount of time spent in an intensive care unit when admitted to a hospital and can cut medical costs.

According to New York City’s Center to Advance Palliative Care, there are about 90 million Americans living with a serious illness, and many of them could benefit from palliative care. There is access to palliative care in about 1,500 hospitals across the country, double the number in 2007. However, most patients are unaware of the specialty and do not know when it might be appropriate for them.

Experts in palliative care say that it should be sought out at the time a serious illness is diagnosed, and it may be appropriate for patients with cancer, dementia and heart or lung disease. Although some patients who are aware of palliative care equate it with hospice, it is not the same thing. Palliative care is appropriate at every stage of a disease and can benefit patients who are expected to live with an illness for a long time. Hospice is a service offered to patients who are likely to live only a few months or a shorter period of time.

However, because palliative care is a treatment for people facing serious or life-threatening illnesses, a person receiving such care may also be facing end-of-life decisions. An incapacitating illness is traumatic for both the patient and his or her loved ones, and it can be especially difficult to make decisions such as whether life-prolonging measures should be undertaken in different medical situations.

These decisions can be made easier by thinking about and communicating your end-of-life wishes while you are healthy. You can communicate your wishes directly to your loved ones, and you can document them in advance directives such as a living will and health care power of attorney. A living will records your end-of-life wishes for your family and your doctors. Because a living will cannot cover every possible situation, you may also wish to name someone to make your health care decisions for you in the event you are unable to do so, through a health care power of attorney.

As medical treatment, including palliative care, improves, people are living longer. Many older people live with serious illnesses or become incapacitated. Taking the time to plan for such possibilities when you are healthy can preserve your wishes and make things easier for your loved ones.

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