The first "palliative care" program was so named by Dr. Balfour Mount of the Royal Victoria Hospital in Montreal, who chose the term to distinguish his program from hospice care. He was concerned that seriously ill patients would reject hospice because of the negative connotations associated with the word: To many, it had come to mean "death" and "hopelessness." "Palliative," from the Latin word pallium, which means to cloak or cover, connotes an action that ameliorates. Dr. Mount used the term to describe medical care that would alleviate the suffering of dying patients and ease their way towards end of life.
Concerns still persist today that dying patients shun hospice care because of the name itself. And as it was for Dr. Mount, this concern continues to be a driving force in the development of palliative care programs; for whatever else it may be, palliative care is not hospice care. But then what exactly is it?
No single definition of palliative care exists, largely because the programs that provide such care are relatively new innovations in the United States and hence are still evolving. Despite some variation, however, the definitions that appear in the literature sound an overall reassuring note of consensus that the term continues to be used much as Dr. Mount first intended. For our purposes, we use a definition put forth in 1997 by a multidisciplinary task force on palliative care sponsored by the Robert Wood Johnson Foundation. That definition:
Palliative care is the comprehensive management of patients' physical, psychological, social, spiritual, and existential needs. It is especially suited to the care of people with incurable, progressive illnesses (Last Acts, 1997).
In our practice at TriCentral, this definition of palliative care is transformed into a specialized form of interdisciplinary health care that is designed to enhance comfort and improve the quality of a patient's life as opposed to achieving a cure. We emphasize care that alleviates the physical, emotional, social, and spiritual discomforts of an individual in the last phases of life. Our treatment goals are pain control, symptom management, quality of life enhancements, and spiritual and emotional comfort for the patient and family.
Remember that our palliative care program, like most such programs across the nation, was launched as an alternative to both hospice care and traditional care practices. On the one hand, patients, their families, and other advocates have expressed dismay with hospice's service restrictions on curative care. On the other hand, when it comes to traditional medical care, these groups are appalled by the intrusive treatment that pummels so many dying patients and their families, prolonging their suffering. Among other intents, palliative care programs aim to restore some measure of choice and control to patients and families at a time when choice and control seem to be slipping away.
The mission of the TriCentral Palliative Care Program reflects a patient-centered approach to care.
Our mission is to achieve the best possible quality of life for the patients through relief of suffering, control of symptoms, and restoration of functional capacity while remaining sensitive to personal, cultural, and religious values, beliefs, and practices. The Program's interdisciplinary healthcare team encourages, honors, and empowers patients and families by welcoming their leadership and collaboration in designing, evaluating and revising their palliative care journey.
The TriCentral Palliative Care Program aims to:
For more information about the TriCentral Palliative Care Toolkit visit www.growthhouse.org/palliative/. All content is Copyright © 2002, 2003 by Richard D. Brumley, M.D. All rights reserved. No part of this toolkit may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publishers. This guide to developing home-based outpatient palliative care services was developed through a grant to the Kaiser Permanente TriCentral Service Area from The Project on Death In America. The Kaiser Permanente TriCentral Palliative Care Program is a Sustaining Member of the Inter-Institutional Collaborating Network On End-of-life Care (IICN) which links major organizations internationally.
