The oncologist spoke with certainty when she told us that any further attempt to treat my mother-in-law’s cancer was useless. As the family slowly came to understand what the doctor was really telling us, we were left with one overwhelming question: “Now what?”
In the past, in situations like this, health care providers and family members would often silently agree to not share the unfortunate news with the patient. It was felt that telling them that further treatment was useless would inflict unbearable pain by depriving them of all hope. What was not fully appreciated was that this conspiracy of silence would isolate the patient physically and emotionally just when they were most in need of a helping hand.
The emergence of palliative care medicine has entirely changed this approach. The basic idea is very simple: tell patients the truth while assuring them they are not being abandoned. The goals may be different, but the patient will have lots of support in achieving their new goals.
For most patients, the biggest concern is avoiding pain. Palliative care involves juggling whatever pain medications and other treatments are needed to keep the patient as pain free as possible while minimizing the undesirable side effects.
There are many other issues besides pain management. Common physical problems such as loss of appetite and difficulty breathing are dealt with. Emotional issues such as depression and fear of dying are addressed. Spiritual and religious needs of the patient are attended to, a source of great comfort to many. Family and friends are encouraged to spend as much time with the patient as possible.
Another important aspect is helping family and friends deal with the impending loss of their loved one.
Traditionally, palliative care would take place in an inpatient setting. More recently, if there is an appropriate support group, the trend is to let patients receive their care in the familiar surroundings of their own home.
Palliative care is not limited to patients with end-of-life issues but is appropriate for many patients with chronic incurable diseases. When applied to patients where curative treatment has been stopped and the life expectancy is less than six months, it is often referred to as hospice care.
Any member of the health care team can help the patient or family begin the palliative care process when appropriate.
Watching my mother-in-law lose her battle with cancer was not an easy process. The burden was greatly eased knowing she had received such wonderful care when she needed it most.
Dr. Stephen Picca of Massapequa is Board Certified in both Internal Medicine and Anesthesiology. He is retired from practice. Questions and comments can be sent to Dr. Picca at firstname.lastname@example.org.