Page 12 - Senior Link Magazine Fall 2017 - Online Magazine

Palliative Medicine vs Hospice

by Dr. Jeremy Brown

My preacher recently said from the pulpit that in benefits. So clinic visits, hospital admissions and
order to remember something, we have to hear prescription co-pays will be billed to the patient
it (read it) 8 times. So…Palliative Medicine is according to his/her plan.
not Hospice. Palliative Medicine is not Hospice.
Palliative Medicine is not Hospice. Palliative Once a Palliative Care patient’s disease process
Medicine is not Hospice. Palliative Medicine is makes the transition from treatable to terminal,
not Hospice. Palliative Medicine is not Hospice. that’s when hospice comes into play. When there
Palliative Medicine is not Hospice. Palliative are no more options for chemotherapy or radiation
Medicine is NOT Hospice. therapy, or when a patient chooses to voluntarily
stop those treatments, hospice is an appropriate
It may seem silly, but I bet you read all 8 of those option. Patients who have declined physically
sentences. And in doing so, I hope that it will set to the point where they are no longer able to get
the framework for this article. As a Hospice and out of their homes, the Heart Failure patient who
Palliative Medicine physician, I can’t think of has 4+ pitting edema and fatigues getting to the
another question I hear more often than, “So what’s restroom, or the COPD patient who is oxygen
the difference between hospice and palliative dependent at all times and short of breath at rest,
medicine?” these are the patients who are likely to be hospice
appropriate.
Palliative Medicine is designed for patients who are
dealing with life-limiting, life-threatening illnesses. By Medicare definition, a person is appropriate for
But they are NOT CONSIDERED TERMINAL! The hospice when death would not be UNEXPECTED
word Palliative is derived from Greek meaning within 6 months. That’s assuming the patient’s
“to alleviate.” The goal for the palliative medicine disease process runs its USUAL course.
patient is to relieve their suffering and reduce their Statistically, when a person has advanced cancer
symptom burden while still seeking aggressive (Stage 4) and has no further treatment options,
treatment for their disease process. or chooses to stop aggressive therapies, 6 months
is the average life expectancy. That means some
The perfect example is a patient with Stage I or people will live less than 6 months, but others will
Stage II cancer. They have a diagnosis that is live longer than 6 months. So a person CAN stay
potentially life-limiting and/or life threatening, on hospice LONGER than 6 months as long as he/
but it’s not considered terminal. They are seeking she is seeking comfort measures only, and as long
remission or even possibly cure, but they have as the prognosis has not changed. While cancer
symptoms that need to be managed by a specialist. is easier to predict prognosis and life expectancy,
These symptoms might include: pain, shortness of other hospice diagnoses such as Alzheimer’s
breath, nausea/vomiting or delirium. Other disease Disease, COPD, Parkinson’s Disease and CHF can
processes that might qualify for palliative medicine be much harder to predict. These patients tend to
include, but are not limited to, Congestive Heart have longer lengths of stay on hospice than those
Failure, COPD, or early stage Parkinson’s Disease. with a cancer diagnosis. An example might be
Also of note when receiving Palliative Care, is that the 80 y/o who has had an ischemic stroke with
the care will fall under a person’s regular insurance dysphagia (difficulty swallowing) and left-sided

12 Lubbock Senior Link