Hospice care and palliative care: Is there a difference between the two, and if so, what? Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care. The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed. Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?

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Palliative Care vs. Hospice Care
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Dr. Jim Meadows
Director of Palliative Medicine
Tennessee Oncology
Board certified in Palliative Medicine & Family Medicine
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7. Palliative vs. Hospice Care
Jim Meadows, MD
Director of Palliative Medicine
Tennessee Oncology

8. Acknowledgement
• Certain topics must be approached carefully

9. Objectives
• What is Palliative Medicine?
• Who can receive Palliative Medicine?
• What are the benefits and risks of Palliative
Medicine?
• Is Palliative Medicine simply hospice care?
• How can I see a Palliative Medicine team?

10. What is it?
• Palliative care is a medical specialty
focused on aggressive symptom
management.
• Experts whose primary goal is to
improve quality of life.

11. What is it?
Palliative care is patient and family-centered
care that optimizes quality of life by
anticipating, preventing, and treating suffering.
Palliative care throughout the continuum of
illness involves addressing
physical, intellectual, emotional, social, and
spiritual needs to facilitate patient
autonomy, access to information, and choice.

12. Why have a specialty?

13. Why have a specialty?
• Diseases are complex
• Treatments are complex
• Symptoms are complex
• Patients are complex
• The system is complex

14. Evolution
• With time, new needs are realized
• Focus on quality is growing
• Knowledge is rapidly expanding
• Benefits are being discovered

15. Who can receive PM
Anyone with a serious condition in
need of improved quality of life,
regardless of prognosis or diagnosis.

16. What’s Quality of Life
How do you measure quality?
Typically includes
Pain Shortness of
Nausea Breath
Anxiety Caregiver Distress
Depression Spiritual Suffering
Fatigue Financial Difficulty
Constipation Loss of Control
Poor Appetite
Insomnia

17. Palliative Medicine in Action
• A patient is referred to a Palliative
specialist
• Palliative visits tend to focus less on
the actual disease and more on what
impact it has on the patient’s life
• Together, a plan of action is reached,
which includes multiple modalities

18. Benefits
• Better control of symptoms
• Better understanding of what effects
a disease has on the patient
• Better communication among the
patient, caregivers, and treatment
team

19. Patient Benefit:
Proof Palliative Medicine
Works
“Do Palliative Consultations Improve Patient Outcomes?”
Casarett D, et al, Journal of the American Geriatrics Society 56 (4) (April): 593-599 (2008)
In a multivariable linear regression model, after adjusting for the likelihood of
receiving a palliative consultation (propensity score), palliative care patients
had higher overall scores: 65 (95% confidence interval (CI)=62-66) versus
54 (95% CI=51-56; P<.001) and higher scores for almost all domains.
Earlier consultations were independently associated with better overall
scores (beta=0.003; P=.006), a difference that was attributable primarily to
improvements in communication and emotional support.
CONCLUSION: Palliative consultations improve outcomes of care, and
earlier consultations may confer additional benefit.

20. Patient Benefit
Phase II Study of an Outpatient Palliative Care
Intervention in Patients With Metastatic Cancer
Follwell, et al. JCO January 10, 2009 vol 27 no. 2 206-213
This study assessed prospectively the efficacy of an Oncology Palliative Care
Clinic (OPCC) in improving patient symptom distress and satisfaction.
• 150 patients enrolled, 123 completed 1-week assessments, and 88 completed
4-week assessments
• The mean improvement in EDS was 8.8 points (P < .0001) at 1 week and 7.0
points (P < .0001) at 1 month
• Statistically significant improvements were observed for pain, fatigue,
nausea, depression, anxiety, drowsiness, appetite, dyspnea, insomnia,
and constipation at 1 week (all P ≤ .005) and 1 month (all P ≤ .05)
• The mean improvement in FAMCARE score was 6.1 points (P < .0001) at 1
week and 5.0 points (P < .0001) at 1 month.

21. Patient Preference
Symptom management needs of oncology outpatients
Whitmer K, Et al. J Palliat Med. 2006 Jun;9(3):628-30
More than half of surveyed patients would attend a symptom management
clinic, if offered, for the following:
• Pain (50%)
• Fatigue (40%)
• Nausea/Vomiting (30%)
• Insomnia (30%)

22. Caregiver Benefit
• 34 million households with caregivers deliver care at home to a
seriously ill older relative (Houser and Gibson 2008)
• On average they’re spending about 21 hours per week in caregiving
• Nearly one-half of all caregivers consider their caregiving
responsibilities to be highly stressful, which puts them at a significantly
increased risk for death, major depression, and other serious illness
(Schulz and Beach 1999)
• A very conservative estimate suggests that family caregivers’ unpaid
contributions are approximately $375 billion per year (Houser and
Gibson 2008)

23. Caregiver Benefit
Patients’ families are not very happy with us as a health care
industry either
• Joan Teno and colleagues (2004) studied caregivers of people who
died in various institutions in the United States.
• 80% reported that patients and families didn’t have enough contact
with their physician and didn’t get enough support
• Half the patients didn’t have enough support or enough information
about what to expect in a setting of serious illness
• Thirty-eight percent of families said they didn’t get enough support and
one in five said they didn’t get enough help with their own emotional
needs.

24. Landmark Research
“Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung
Cancer.”
Temel JS, et al. New England Journal of Medicine 363 (8) (August 19 2010): 733-742.
• Patients assigned to palliative care had better quality of life, reflected in a
mean FACT-L score of 98.0 at 12 weeks compared with 91.5 for the control
group (P=0.03)
• Additionally, only 16% of the palliative care group had depressive symptoms
versus 38% of the control group (P=0.01)
• Palliative-care patients were also less likely to receive aggressive end-of-life
care. The authors reported that 33% of patients receiving palliative care had
aggressive end-of-life care versus 54% of the standard-care group (P=0.05).
• Median survival in the patients who received early palliative care was 11.6
months compared with 8.9 months in the control group (P=0.02).

25. Landmark Research

26. Landmark Research

27. ASCO
Provisional Clinical Opinion: Based on strong evidence from a phase III
RCT, patients with metastatic non–small-cell lung cancer should be offered
concurrent palliative care and standard oncologic care at initial diagnosis.
While a survival benefit from early involvement of palliative care has not yet
been demonstrated in other oncology settings, substantial evidence
demonstrates that palliative care–when combined with standard cancer care or
as the main focus of care–leads to better patient and caregiver outcomes.
These include improvement in symptoms, QOL, and patient satisfaction, with
reduced caregiver burden. Earlier involvement of palliative care also leads to
more appropriate referral to and use of hospice, and reduced use of futile
intensive care. While evidence clarifying optimal delivery of palliative care to
improve patient outcomes is evolving, no trials to date have demonstrated
harm to patients and caregivers, or excessive costs, from early involvement of
palliative care. Therefore, it is the Panel's expert consensus that combined
standard oncology care and palliative care should be considered early in the
course of illness for any patient with metastatic cancer and/or high symptom
burden. Strategies to optimize concurrent palliative care and standard
oncology care, with evaluation of its impact on important patient and caregiver
outcomes (eg, QOL, survival, health care services utilization, and costs) and
on society, should be an area of intense research.

28. Palliative vs. Hospice
• Both focus on improved qualify of life
• Both are delivered by specialists
• Both have been shown to improve
survival

29. Palliative vs. Hospice
• Both tend to be delivered by a team
of individuals with knowledge of
complex symptom management
• Both work with the patient’s other
clinicians to provide an additional
layer of patient care

30. Palliative vs. Hospice
• Hospice is a medical insurance
benefit, with its own set of
regulations
• Hospice care is typically provided in
the home, whereas palliative tends
to be hospital or clinic based

31. Palliative vs. Hospice
• Hospice specifically cares for
patients with terminal conditions
where survival is typically <6 months
• Palliative medicine is delivered
irrespective of prognosis
• Both are provided regardless of
diagnosis

32. Palliative vs. Hospice

33. Palliative vs. Hospice

34. Palliative vs. Hospice

36. Involving Palliative Care
• Talk with your oncologist
• Palliative Care and Medical Oncology work
as a team
• Use online resources to find local
programs
• www.getpalliativecare.org
• Once arranged, have open, honest
dialogue

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