Palliative Care and its Role in Chronic Conditions
At its inception, palliative care was interwoven with the hospice movement, and because of this it is often perceived as solely a component of hospice care. However, palliative care and the interventions it provides have expanded in scope to include much more than end-of-life care.
Today, palliative care is becoming recognized as a key component of complex chronic disease management and its utility is rapidly expanding as providers and payers are discovering the benefits of implementing it. For palliative care to have maximum impact on outcomes and quality of life for patients, ideally it should be introduced as early as possible in a disease process, preferably at the time of diagnosis. Why is this, and what is palliative care’s role in chronic conditions?
Palliative care goals in chronic conditions
Chronic health conditions represent a major concern for patients and providers alike. In the United States today, according to the Centers for Disease Control and Prevention (CDC), 6 in 10 adults are living with a chronic disease, 4 in 10 have two or more chronic conditions, and these conditions are a primary contributing factor to 4.1 trillion dollars in annual healthcare costs.
When we think about chronic diseases like heart disease, pulmonary conditions like chronic obstructive pulmonary disease (COPD), and cancer diagnoses, palliative care holds a unique ability to help mitigate costs for all stakeholders and to reduce suffering for patients.
In the setting of chronic conditions, palliative care becomes the cornerstone of managing better outcomes. This is because there are many facets of disease care that go beyond treatments, starting at the time of diagnosis.
As a specialty, palliative care focuses on these goals of care for chronic conditions:
- Support and education for the patient and family/caregiver
- Symptom management and quality-of-life concerns
- Care coordination and navigation
- Advanced care planning
When introduced at the outset of a patient’s journey with a chronic condition, the support and education available through palliative care defines it as a specialty that is well-qualified to assist its patient population with managing chronic disease.
Why palliative care’s support for patients with chronic conditions is essential
The support and education piece of palliative care is one of its primary goals in chronic disease management. A patient with a new diagnosis of a complex chronic illness faces many challenges that are often lost in the traditional approach to disease management.
Although the diagnosis may represent a disease that is manageable or even has potential to be cured, patients need to understand what’s likely to happen now that they’ve received this diagnosis, and what’s likely to happen once they start treatment. When palliative care is introduced at this early stage, it can help support better long-term understanding.
This understanding allows patients to participate in their plan of care more proactively. As the disease process unfolds, patients who aren’t prepared often find themselves in a crisis and needing to make decisions based on a weak knowledge base. This is especially true, for example, when symptom management becomes a high priority.
To help patients prepare for their journey with a chronic disease, palliative care addresses concerns such as:
- How do I tell my family about my diagnosis?
- Can I expect the diagnosis to interfere with my job? How?
- How do I afford the treatment or caregiver support necessary?
- What kinds of complications and symptoms might I experience as part of the disease process?
- What kind of care do I want when I experience complications and symptoms?
This psychosocial support and attention to ensuring the right conversations happen at the right time, with the right people, can have a positive impact on the long-term treatment plans, decision-making, and patient investment in their current treatment.
Why palliative care is not hospice
Fundamentally, because palliative care, unlike hospice, can be introduced even if the patient is not terminally ill and does not require the patient to forgo curative treatment, it is its own standalone specialty. Hospice care is only a part of palliative care if and when the patient is determined to be appropriate for and elects this type of care approach.
Palliative care does not require that a cancer patient forgo chemotherapy or that a patient with kidney disease forgo dialysis; and palliative care is not just a bridge to hospice or end-of-life care. Instead, it helps facilitate the patient’s treatment regardless of the patient’s long-term goals.
For example, palliative care, when introduced at the onset of oncology care for a cancer diagnosis, provides its own specialized focus that works in tandem with curative treatment. While an oncologist may organize treatment such as chemotherapy designed to irradicate the disease, palliative care can provide support in managing symptoms like fatigue, nausea, and the brain fog known as “chemo brain” that often accompany cancer treatment.
If the patient achieves remission, the goals of care may change. If the patient eventually requires hospice care, palliative care can support them— facilitating their understanding well ahead of that phase of the illness— and become integrated with hospice care as well.
Is palliative care in competition with other goals of care for chronic disease?
If palliative care is different from hospice care, does it ever complicate the traditional management of chronic conditions? In today’s often fragmented healthcare systems, organizing goals of care between more specialists can often be seen as more complex.
This is where palliative care shines. The aforementioned patient support and education, along with care coordination, means that palliative care has a pivotal role in reducing healthcare fragmentation and ensuring that all goals of care are cohesive and aligned with the patient’s desires. An increasing body of evidence points to palliative care outcomes that include lower healthcare utilization, improved patient and caregiver satisfaction, and better advanced care planning.
The growing role of palliative care in complex disease management
As palliative care continues to grow and become more readily available, especially within communities with services like Amedisys and Contessa’s Palliative Care at Home program, it is breaking through access barriers. More health systems are implementing it; use of in-hospital palliative care programs has tripled since 2020. And more payers are incorporating it into their services to help lower costs for patients with complex chronic illnesses.
With Palliative Care at Home, the opportunity exists to take palliative care outside of traditional care settings and fully integrate it into the communities it serves. The growing healthcare at home continuum is continuing to evolve, and as a part of that, it is easy to see why palliative care will continue to be at the forefront of managing chronic conditions.