Chapter 81: General Topics in End-of-Life Rehabilitation

INTRODUCTION

At first glance, the fields of rehabilitation medicine and palliative medicine might seem to be diametrically opposed, but, in fact, they have much in common. Both fields provide whole-person care to patients and their families through interdisciplinary teams. Central to palliative care is the development of an individualized patient care plan that focuses attention to pain and symptom control and to maximizing the patient's function, independence, and quality of life. The patient's goals of care direct the plan of care, with the plan modified by change in the patient's condition over the course of time. Palliative care should be part of the treatment plan for every patient of any age who has a serious illness, no matter the stage of illness, and rehabilitation medicine providers often figure prominently in a patient's early palliative care plan. Figure 81–1 demonstrates the role of palliative care through the course of serious illness.¹

Compared to usual preventive and interventional medical care, palliative care focuses on symptom management and quality of life more than curative or disease-modulating measures, although palliative care should be started even while patients continue in active treatment against serious diseases. Dr. Balfour Mount of Quebec is credited with the first use of the term palliative care.² The term comes from the Latin root palliare (“to cover” or “to cloak”).³ The World Health Organization's definition of palliative care emphasizes patient-centered, holistic, interdisciplinary care of physical, emotional, and psychological distress for patients and their families (Table 81–1).⁴