Hospice and palliative medicine

Hospice and palliative medicine can define several things, such as an interdisciplinary subspecialty for physicians, advanced training for nurses and other health professionals, a philosophy or set of techniques for end-of-life care, and either a synonym for or a subset of the hospice movement. It is no longer limited to humans, but is part of high-quality veterinary medicine.

Some of the goals and techniques focus on palliative care, which is improving quality of life while addressing the physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, including through the dying process and subsequent family grieving.

Hospice and palliative medicine as a medical subspecialty

A subspecialty involving end-of-life care, working with an interdisciplinary hospice or palliative care teams. This care can occur within or outside of a formal hospice or palliative care team. Such a physician has expertise in the assessment of patients with advanced disease and catastrophic injury; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse settings; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care. Training in working with related disciplines including nursing, pastoral care, pain medicine, palliative radiation therapy and surgery, social work, physical therapy, occupational therapy and complementary and alternative medicine.

The subspecialty fellowship can be reached through a number of pathways besides radiology, including internal medicine, anesthesiology , emergency medicine, family medicine, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, psychiatry and neurology, and surgery.

Veterinary hospice care

The principles of hospice care are entering the practice of veterinary medicine. Many of the same principles apply, although cost, the greater acceptability of euthanasia, and a lesser range of treatments than available to humans can complicate the situation. One change is recognition that oral administration of drugs may be extremely distressing to companion animals, but that owners can often be trained to use injectable drugs.

Treatments

Often, it is the anticipation of pain, rather than the pain itself, that is most distressing to patients. Techniques, developed for palliative care, have now become standards for terminal and nonterminal pain management. For example, if the patient has a painful condition, analgesics should never be prescribed on an as-needed basis, but administered on a regular basis, or even continuously (e.g., through pumps or transdermal patches), so the blood level never drops to a point where the patient craves relief. There certainly can be "breakthrough" pain beyond the baseline, and the treatment team must be prepared to recognize it and respond with appropriate treatment.

Music therapy may be helpful at the end of life.