What is palliative care?
Palliative care is designed to help a person have the best possible quality of life as his or her cancer progresses. The focus of palliative care is not on dying or trying to find a cure. Instead the focus is on living each remaining day as fully as possible.
The following are the main goals of palliative care:
- To relieve pain and other symptoms
- To help improve emotional, mental and spiritual well-being
- To support the family members of the person who has cancer during his or her illness and after his or her death
Palliative care involves a partnership between the person who has cancer, his or her family and friends, and the members of the health care team. This team may include the services of a doctor, nurse, social worker, counselor and spiritual advisor.
Where is palliative care provided?
Palliative care can be provided at home or in a hospital or hospice facility. The person who has cancer and his or her family members will have to decide which option is best for them. Before making this choice, it's a good idea to find out as much as possible about each care setting. It can also be helpful to talk with a doctor or other members of the health care team about the good and bad points of each option. It may be possible to receive care at home for a while and then move into a hospital or hospice facility as the cancer progresses. If a person prefers to receive care at home, family members may want to ask the doctor for information on local support programs. For example, some programs offer the services of respite care workers. These workers take over the person's care for a few hours to give the primary caregivers a break.
How can palliative care relieve pain and other symptoms?
As a person's cancer advances, he or she may experience a number of symptoms. These symptoms may include pain, loss of appetite, fatigue, weakness, weight loss, constipation, trouble breathing, confusion, nausea, vomiting, cough and a dry or sore throat. All of these symptoms can be managed with appropriate treatment. A person who has cancer shouldn't try to "be strong" and tolerate pain or other symptoms. This can have a negative effect on the person's physical and emotional state. A person who has cancer should tell the doctor about any symptoms he or she is having.
Pain is one of the most common symptoms experienced by people who have cancer. Even if it is severe, the pain can almost always be controlled with medicine. Each person responds to pain differently. The doctor will create a pain management plan that meets the person's needs. Pain medicines can be given by mouth (liquid or pill) or through the rectum (suppository). They can also be given through the skin (transdermal patch) or injected into the skin, a muscle or a vein. The caregiver should know that chronic (ongoing) pain needs to be treated on a regular schedule. It is important not to wait until the person feels pain before giving the next dose, even if this means waking him or her up in the middle of the night.
For some people, the doctor may prescribe an opioid medicine, such as morphine or codeine, to relieve pain. Opioid pain medicines often cause constipation (difficulty having bowel movements), so the person who has cancer may also need to take another medicine on a regular basis to prevent this common side effect. The person in pain may be worried about getting "hooked" on an opioid pain medicine. However, addiction to pain medicine is very rare in people who have cancer.
It may take several tries for the doctor to find the most effective way to ease pain symptoms. The person in pain shouldn't feel discouraged if a particular approach doesn't work. The doctor needs to know about the person's preferences for how pain symptoms are managed. Helping to direct the course of his or her care may help the person who has cancer feel more in control of the situation.
How can a person who has cancer prepare to face the end of life?
Each person will face the end of life in his or her own way. It's normal to feel everything from disbelief and anger to acceptance of the situation. People may struggle with regret for the way they've lived or things they've done. They may worry about becoming a burden on the family or about how family members will manage without them. These feelings and fears are normal. However, they can negatively affect a person's quality of life if he or she does not deal with them.
Palliative care offers the opportunity to find peace of mind by facing feelings and beliefs about life and death. Each person must find meaning in his or her own way, at his or her own pace. Some people find comfort in talking with a close friend, family member, spiritual advisor, counselor or support group about their feelings. Others may prefer to deal with their emotions in another way, such as writing in a journal, painting or listening to music.
How will family members react to palliative care?
As the death of a loved one grows near, each family member will react differently. It is common to experience a range of emotions, such as anger, shock, anxiety and helplessness. There is no single "right way" to deal with this situation. Family members should try to accept one another's different responses and feelings. Also, they should keep in mind that emotions don't follow a time schedule. Just because one person is ready to move on to the next stage of grieving doesn't mean everyone else is. As part of palliative care, it's important for family members to make the most of the time they have with their loved one rather than focusing on his or her death.
What else should a person do when preparing to face the end of life?
Palliative care offers an opportunity to make practical preparations for death. This can be a very difficult process. However, dealing with these matters in advance can reduce the financial, legal and emotional problems that a person's family and friends will face after his or her death. It also gives the person who has cancer some control over his or her situation. For example, preparing a will allows a person to decide how his or her possessions are divided. During this time, the person who has cancer may want to organize any records, documents and instructions that family members will need after his or her death.
A person who is facing the end of life may want to make his or her wishes regarding a funeral or memorial service known. If these preferences are discussed with family members, the funeral or memorial service can be a very personal reflection of the person's life and how he or she wants to be remembered. Careful planning can also reduce some of the stress that family members experience after their loved one's death.
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.