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
The place of palliative care in the course of illness. (Adapted from Clinical Practice Guidelines for Quality Palliative Care. National Coalition for Hospice and Palliative Care. Available at: www.nationalconsensusproject.org)
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
Table 81–1World Health Organization Definition of Palliative Care ||Download (.pdf) Table 81–1 World Health Organization Definition of Palliative Care
Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. Palliative care:
Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
Provides relief from pain and other distressing symptoms.
Affirms life and regards dying as a normal process.
Intends neither to hasten or postpone death.
Integrates the psychological and spiritual aspects of patient care.
Offers a support system to help patients live as actively as possible until death.
Offers a support system to help the family cope during the patient's illness and in their own bereavement.
Uses a team approach to address the needs ...