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Palliative Care: A Primary Care Perspective

There are many stages of health in a person’s life. Most of us begin with wellness, during which prevention is the primary medical intervention. At some point, however, one or more chronic diseases usually develop. Examples of chronic disease include diabetes, congestive heart failure or even cancer. Eventually, patients reach the stage of terminal illness, which signifies the final stage of life.

During the stage of chronic illness, physicians focus on the treatment of disease. Primary care doctors recommend lifestyle changes, prescribe medications, and occasionally refer to specialists for additional expertise. But, sometimes the impact of the disease on a patient’s life is overlooked. For example, a person with diabetes might develop a painful condition called neuropathy. This pain can interrupt sleep and lead to depression. The depression can interfere with the patient’s motivation to engage in the treatment recommendations. Hence, a vicious cycle begins.

Palliative care is the acute, aggressive treatment of the symptoms of chronic disease. So what does that mean? It means that palliative care actively manages the side effects of chronic disease, and their impact on overall quality of life.

In the earlier example with diabetic neuropathy, the palliative care provider could help to manage the pain, and therefore the subsequent insomnia and depression. By controlling these symptoms, the patient can focus on the other aspects of treating the diabetes—such as a healthy diet, exercise, and medication compliance.

Palliative care returns control to the patient. Providers work with patients and their families or caregivers to understand the patient’s goals and to identify barriers. Once identified, the palliative care team can assist the patient in removing those barriers to facilitate the attainment of the patient’s life goals.

Too often, palliative care is delayed until people are well into the terminal stages of life. At that time, palliative care—under the auspices of hospice—is then considered. But engaging patients in palliative care early in the process of chronic disease can greatly improve outcomes and quality of life well before the terminal stage is reached. Patients receiving palliative care often have fewer visits to the emergency department or to the hospital. They can, then, spend more time doing meaningful activities, like traveling or watching their grandchildren play soccer!

The practice of medicine cannot cure all diseases. But timely, aggressive treatment can manage most illnesses.

Kristen K. Brown, MD

VP of Physicians Network, Mercy Health Partners