The Palliative Care vs. Hospice Decision

Because both groups offer support and care with an emphasis on quality of life, the decision on palliative care vs. hospice can be difficult. The only way to make the choice is to consult with the patient’s physician.

palliative care

Because both groups offer support and care with an emphasis on quality of life, the decision on palliative care vs. hospice can be difficult.

© Robert Kneschke | Dreamstime.com

“All hospice care is palliative, but not all palliative care includes hospice,” says the Hospice Foundation. No wonder palliative care vs. hospice presents such a quandary for those dealing with a serious illness. As confusing as that definition is, however, it’s spot on.

When you do a side-by-side comparison of palliative care vs. hospice you learn that both offer care and support to the seriously ill. Both work to relieve the pain and emotional stresses associated with the illness, and both involve a team of family members, doctors, nurses, chaplains, and other medical and spiritual support professionals.

The factor that decides palliative care vs. hospice is the patient’s prognosis. If the patient is continuing treatment and has hopes of a longer life, palliative care is the correct option. Patients with renal disease, disabling cardiac disease, Alzheimer’s, Parkinson’s, cancer, neurological disease—any debilitating disease where there is still hope—can benefit from palliative care.

If the doctor believes the patient is within six months of death—without any viable treatment options—the correct choice is hospice. Hospice is end-of-life care, when there are no options for treatment remaining. Note: Many hospice organizations also offer palliative care, adding to some of the confusion.

Quality of Life

Location isn’t an issue when deciding palliative care vs. hospice. Both programs can be offered wherever the patient is—home, hospital, nursing home.  However, for most patients, hospice is centered around the patient’s home.

Hospice is not a “giving up” option; it is a quality-of-life option. Hospice provides dietary guidance, physical therapy, occupational therapy, and durable medical goods like wheelchairs—all to make the most out of what time a person has left. Hospice is compassionate, giving medical treatments for pain and symptom relief but not for the disease itself. The six-month rule-of-thumb isn’t a hard rule either.  If the patient’s treatment options have run out, hospice is the choice for however long the patient lives.

Making the Most of the Remaining Time

In a University of California at San Diego study published in International Psychogeriatrics, researchers asked 21 hospice patients, ages 58 to 97, whether their terminal illnesses had changed or impacted their understanding of wisdom. The study authors said a recurring theme was the patients’ search for acceptance or peace related to their illness, particularly in terms of physical changes and loss of functioning.

“It wasn’t passive ‘giving up,’ but rather an active coping process,” says first author Lori P. Montross-Thomas, PhD. “They emphasized how much they appreciated life, taking time to reflect. There was a keen sense of fully enjoying the time they had left and in doing so, finding the beauty in everyday life.”

Patients also spoke of “galvanized growth,” said senior author Dilip V. Jeste, MD. The patients talked about adaptive characteristics “stimulated and forged by the difficulty of living with a terminal illness, such as greater determination, gratitude and positivity. The growth was linked directly to an increase in wisdom.”

While palliative care also emphasizes quality of life, it is designed to support the patient throughout whatever difficult illness the person is enduring. Palliative care includes medical treatments for the disease itself, as well as drugs that address symptoms. For example, says the Hospice Foundation, palliative care offers support during chemotherapy, which can be an extremely physically and emotionally taxing therapy. An article published in the Journal of Clinical Oncology, by the American Society of Clinical Oncology, recommends cancer patients receive palliative care early in their treatment plan.

“Respecting the desires of patients—as well as their families and their caregivers—palliative care seeks to improve quality of life in the face of serious illness,” says Donna Kamann, a palliative care nurse practitioner at Mayo Clinic Health System, in the Mayo Clinic’s paper, “Evolving roles of hospice and palliative care.” Palliative care can be implemented at any stage of an illness, although if the disease progresses far enough, the patient may be transitioned to hospice.

Palliative Care vs. Hospice

The Centers for Medicare and Medicaid Services addresses the issue of palliative care vs. hospice with a simple list:

Palliative Care

  • Focuses on relief from physical suffering.
  • The patient may be being treated for a disease or may be living with a chronic disease and may or may not be terminally ill.
  • Addresses the patient’s physical, mental, social, and spiritual well-being, is appropriate for patients in all disease stages, and accompanies the patient from diagnosis to cure.
  • Uses life-prolonging medications.
  • Uses a multi-disciplinary approach using highly trained professionals.
  • Is usually offered where the patient first sought treatment.

Hospice Care

  • Specifically for terminally ill patients when it is determined treatment for the illness will no longer be pursued.
  • Makes the patient comfortable.
  • Prepares the patient and the patient’s family for the patient’s end of life.
  • Does not use life-prolonging medications.
  • Relies on a family caregiver and a visiting hospice nurse.
  • Is offered at a place the patient prefers such as in their home; in a nursing home; or, occasionally, in a hospital.

No matter which way you lean when it comes to palliative care vs. hospice, facing a difficult, life-engulfing illness can push family ties to the absolute limits.  The care and support these professionals can make a world of difference in learning to accept what is happening and ensuring that everyone involved can not only cope with the road ahead but learn to find joy in the time spent with loved ones.

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