Does My Loved One Need Palliative Care?

Whether or not to pursue palliative care is a very personal decision. It is one best made after talking with the patient's physician and getting as much information as possible about your loved ones condition. The doctor will be looking for the following when considering palliative care for your loved one:

• Does he/she have cancer or other illness that cannot be cured?
• Is he/she expected to live one year or less (or six months or less for hospice)?
• Are there other serious medical problems that complicate the disease?
• Has the patient or family requested palliative care?

• If the answer to any of these questions is “yes”, then your loved one may need palliative care.

Life Expectancy

It is usually very difficult to predict an exact amount of time a person is expected to live with a life-threatening illness. Doctors do their best to make as accurate a prediction as possible but because each individual is so different, their disease will run its own unique course. There are several factors that help doctors decide if a patient has one year or less, such as whether the patient can still care for themselves and carry one with daily activities of living. A doctor will also be looking for the presence of serious complications of disease such as liver, kidney, or nervous system failure.

Questions for the Doctor

There is additional information you will need from the doctor before you can make your decision. Be sure to ask the following:

• What are the benefits and risks of continuing with curative treatments such as chemotherapy, radiation, dialysis, etc.
• What benefits would we receive from palliative care that we wouldn’t get otherwise?
• What, if anything, would we loose by choosing palliative care?
• Would my loved one have to discontinue all curative treatment if we elect palliative care?

Okay, Now What?

Now that you are equipped with more information from your doctor, you need to ask yourself and/or your loved one four important questions.

1. Do the benefits of aggressive curative therapy outweigh the risks? Are we willing to face the risks and continue with it?
2. What is most important to us and what do we hope to achieve with any type of treatment?
3. Does my loved one have an Advanced Healthcare Directive and if so, what does it state regarding his/her wishes?
4. What kinds of support do we have in place to assist us with care and do we have resources to obtain more support if needed?

For Example...

To illustrate a typical situation, we will review the case of "Judith Black" (not her real name). Judy has had dementia for several years that has just recently gotten much worse. She is living in a long term care facility and her family visits often. She is now refusing to eat and won't take her medications. The nurses at the facility told Ms. Black's family that if she doesn't get the proper nutrition, she will die.

Ms. Black's family decides to hold a family meeting with her doctor. He confirms that without proper nutrition, her life expectancy could be weeks to months. He informs them that this is an expected course of the disease of dementia. He also informs them that because her nutrition and hydration is so poor, Ms. Black's kidneys are begining to fail. He gives them the choice to either insert an IV and gastric tube to feed Ms. Black artificially or to refer Ms. Black to hospice care.

Ms. Black's family then decides to review her living will, which states that she wishes to not be fed artificially if she has a life threatening disease that she will not recover from. They had had several conversations with Ms. Black in the past, before her dementia was severe, about her wishes and recall that she desired to be comfortable and surrounded by her loved ones above anything else. Ms. Black's family decide that inserting an IV and gastric tube would only make her more uncomfortable and only prolong her inevitable death from dementia. They decide to consult with hospice.

A hospice nurse assess Ms. Black and meets with her family. She reviews Ms. Black's care and offers treatments that may improve Ms. Black's comfort and increase her appetite. A social worker from hospice meets with the family and after learning how much they would like her home, designs a plan to discharge her from the nursing facility and into the family's home.

Ms. Black was able to go home with her family and while efforts to increase her appetite failed, she was comfortable. Her family was able to pool resources to care for Ms. Black during the short time she was at home and hospice visited several times a week. Ms. Black died two weeks after coming home from the nursing facility and her family was at peace, having provided her with the kind of death she desired.

While this is only one example of one family's decision process, it illustrates how the family was able to gather information from various sources and reach a decision that everyone agreed on. It may not always be this easy. Sometimes family members disagree and sometimes the course of an illness is not that predictable. If you are still having difficulty deciding if palliative care is right for your loved one, please take the time to browse through this site to gain additional insight into palliative care and hospice.