Viki will be presenting with POLST Coalition in L.A. on 10/28/10

The Coalition for Compassionate Care of California is a statewide partnership of more than 95 regional and statewide organizations dedicated to the advancement of palliative medicine and end-of-life care in California. Their mission is to promote high-quality, compassionate end-of-life care for all Californians.

POLST (Physician Orders for Life-Sustaining Treatment) is a form that states what kind of medical treatment patients want toward the end of their lives. Printed on bright pink paper, and signed by both a doctor and patient, POLST helps give seriously ill patients more control over their end-of-life care.

Membership is open to any organization or individual that wants to support high-quality, compassionate end-of-life care for all Californians.
Membership Benefits include:
* Connection to a statewide, multi-disciplinary effort to ensure quality end-of-life care
* Access to cutting-edge ideas, tools and resources
* Timely legislative updates
* Networking at the annual CCCC membership conference
* CCCC’s monthly email newsletter
* Listing as a member on the CCCC website
* Discounted registration fees for selected CCCC programs, events and materials
* Being part of a larger public policy voice to impact end-of-life issues

Have a kind and respectful day.

What is the difference between palliative care, comfort care and hospice care?

Dear Viki,

I’m kind of confused because I don’t understand the difference between hospice care, palliative care and comfort care. Is there a difference between these and if so, why do each of the doctors say different things? What are they trying to tell me?

Great question. I think sometimes even doctors and nurses get confused by these different words to describe pain management and end-of-life care. The words do mean different things but many times they are used to describe the same thing, the support your loved one will get during the dying process. In practice, doctors may be saying the same things even though they are using different terms. Let me try to explain.

Let’s start with palliative care. This is the most misused term because it describes both pain management when you’re healthy and the support you receive during the dying process. Palliative care is the global word to describe all of the care that is related to relieving suffering. Let me say it in a different way. To palliate means to relieve or lessen without curing, to mitigate or to alleviate. So sometimes the patient may go to a palliative care specialist, even though they’re not dying, to help them get their pain under control or to alleviate their physical symptoms. They’re not dying, they are just asking for good pain management. It frustrates palliative care specialists when people think that all they do is take care of the dying. This isn’t true. They take care of the suffering of all patients. And one group of these patients happens to be the dying.

Hospice care is for people in the dying process. A patient can get palliative care without dying but you can’t get hospice without being a dying patient. There are also different kinds of hospices, both volunteer hospices and medical hospices. I volunteer at a volunteer hospice and we provide respite care and support for the patient and family. We are like a good friend who stops by to help out. A medical hospice will provide volunteers as well as visits from nurses, doctors, social workers, chaplains and nursing aids as well as providing the patient at no cost, symptom management medications, medical equipment and oxygen etc.

Hospice care can also be found in different locations. It doesn’t always happen in the patient’s home. It can also be found in an outpatient hospice, an inpatient designated bed in the hospital, in a skilled nursing facility, a board and care or assisted living facility. Your location shouldn’t determine your eligibility for hospice, although there are a few facilities who are not accredited to have hospice patients in their facility.

Now let’s talk about comfort care. This is a word that is most often used inside of a hospital. At some point, the doctor may come in and talk to the patient or the loved one about putting the patient on comfort care. Here is what they’re trying to say. They are saying that, at this point they have nothing else they can do to cure your loved one’s disease. But what they can offer you is to keep them comfortable and to help them have a good death. It may not mean that your loved one is dying immediately but that the aggressive treatments that they have been trying are not working to get them better. And now they want to focus on relieving the suffering and keeping your loved one comfortable. They are not abandoning the patient but they are changing the focus from curing to caring.

Now maybe you’re saying to yourself, isn’t the relieving of suffering like palliative care? Isn’t comfort care, palliative care? This is where it gets confusing again. Remember that palliative care is for both when someone is fighting their disease and when a person is in the dying process. In reality, the patient should be getting palliative care throughout their medical treatment experience. But sometimes palliative care is brought in very late and only as part of the comfort care (dying) plan. So you will want to speak up and ask for good palliative support while your loved one is healing and later on when they are dying. Patients should not be suffering or be in pain. Doctors now know how to take care of these symptoms, but if your doctor doesn’t or won’t help, then ask for a referral to someone who does. But be careful because some doctors will think you mean palliative care as in dying support. Make sure you explain what you are asking for, recovery support or dying support.

So, back to your question: If the doctor in the hospital says comfort care, they mean dying care. If they say palliative care in the hospital, they probably mean dying but they might just mean suffering care. You will need to clarify this with them. If they say hospice, then that means you will probably be discharged from the hospital to go home to die.

If a doctor wants to make the patient comfort care in the hospital, the patient can probably go home on hospice or perhaps to a facility that can handle their medical situation with hospice support. If your loved one wants to die at home, you need to advocate for them and say, “They would like to go home on hospice.” You need to speak up about where and how your loved one would like to die. They are entitled to a good death and so are you.

Have a kind and respectful day.

“How do I know it is time for hospice? – Information for doctors and their patients” with Dr. Christian Sinclair, on May 29th, 2PM pst

Dr. Christian Sinclair, “How do I know it is time for hospice? – Information for doctors and their patients. on May 29th, 2PM pst”

Dr. Christian Sinclair is a palliative care expert and is the co-editor of the Pallimed: A Hospice & Palliative Medicine Blog. http://www.pallimed.org/     Dr. Sinclair is the Associate Medical Director of the Kansas City Hospice and Palliative Care. www.kansascityhospice.org He is also on the Board of Directors of the American Academy of Hospice and Paliative Medicine.   www.aahpm.org

You can also contact Dr. Sinclair on Twitter: @ctsinclair

About Me (Christian Sinclair)

My medical training started at the University of California, San Diego, which I completed in 2000. From there my wife, Kelly, our dog and I went to North Carolina for 4 years for my Internal Medicine residency at Wake Forest. My 4th year was spent doing a palliative medicine fellowship at the Hospice and Palliative Care Center. I now have been working since the summer of 2004 at Kansas City Hospice & Palliative Care as a associate medical director. I was also the fellowship program director for the KC Hospice Palliative Care fellowship from 2006-8. I am a big advocate for palliative medicine fellows, and have been the chair of the AAHPM professionals-in-training special interest group (PIT-SIG). I was elected to the AAHPM Board of Directors in 2009.   www.aahpm.org