TIME, CONVERSATION AND ONGOING
ASSESSMENT: What Palliative Care
Means To Me
Jane Cornett, MD
W
hat is palliative care? It is
more than the care of the
imminently dying, and
it is more than hospice
care. Palliative care is
an approach; it is a philosophy of care and
medicine. Palliative care counterbalances
aggressive care. In my 30 years of medical
practice, acute care medicine has evolved in a direction of
specialization, often looking at people as individual organ systems.
Palliative care looks at individuals as a whole with their goals and
frailties. It acknowledges that people wear out. They often die of
multisystem disease and failure to thrive, rather than any acute
event or single illness. In the face of terminal or life-limiting
disease, it focuses on how we make today a better day rather than
on how to be saved for tomorrow.
As a medical approach, palliative care focuses on symptom
control and minimizing medications. It is absolutely not about
“drugging people up,” as some believe, or removing medications to
hasten death. It is the judicious use of medications based on disease
process and prognosis and symptom management, with the goal
of alleviating pain and sufferings in addition to minimizing pill
burden, and often undue side effects. Palliative physicians and
providers work diligently to connect with patients and families to
help explain disease process, prognosis and expected outcomes in
an effort to establish a plan of care based on their goals, with a
realistic understanding of their disease.
Palliative care is not a “one size fits all” form of care. It is broader
and more inclusive than hospice care. In a palliative approach
to care, practitioners navigate treatment with their patients,
adjusting and re-adjusting medical care based on clinical changes,
in addition to providing continuous education and preparation of
patients and families in relation to expected outcomes, and/or life
expectancy. Some palliative patients have a prognosis of months
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MARCH 2019
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