___________________________________________ Palliative Care and Pain Management at the End of Life
COMPARISON BETWEEN PALLIATIVE CARE AND HOSPICE
Palliative Care a
Hospice b
Condition
Cancer
Uncontrolled signs and symptoms due to cancer or treatment Introduced at time of diagnosis if disease terminal Introduced when disease progresses despite therapy Stage III or IV heart failure despite optimal medical management Angina refractory to medical or interventional management Frequent emergency department visits or hospital admissions Frequent discharges from implanted defibrillators despite optimal device and antiarrhythmic management
Any patient with metastatic or inoperable cancer
Heart disease
Heart failure symptoms at rest Ejection fraction less than 20% New dysrhythmia Cardiac arrest or syncope Frequent emergency department visits for symptoms
Pulmonary disease Oxygen-dependent, O 2 saturation less than 88% on room air Unintentional weight loss
Dyspnea at rest Signs or symptoms of right heart failure O 2 saturation less than 88% PCO 2 greater than 50 Unintentional weight loss Unable to walk, bathe, or dress self without assistance Incontinence Less than six intelligible words Frequent emergency department visits International normalized ratio greater than 5 Albumin level less than 2.5 g/dL Refractory ascites Spontaneous bacterial peritonitis Jaundice Malnutrition and muscle wasting Not a candidate for dialysis Creatinine clearance of less than 15 mL/minute Serum creatinine level greater than 6 mg/dL
Dyspnea with minimal-to-moderate exertion Other pulmonary diagnoses (e.g., pulmonary fibrosis, pulmonary hypertension) Behavioral problems Feeding problems, weight loss Caregiver stress Frequency of emergency department visits Increased safety concerns Increased need for paracentesis for removal of ascitic fluid Increased confusion (hepatic encephalopathy) Symptomatic disease
Dementia
Liver disease
Renal disease
Dialysis Stage IV or stage V chronic kidney disease
Neurologic disease Stroke Frequent emergency department visits Albumin level less than 2.5 g/dL Unintentional weight loss Decubitus ulcers Homebound/bed confined a Serious illness diagnosis and significant symptoms burden, or significant psychosocial distress, or need for assistance with decision-making, delineating goals of care, or need for increased support. b Limited life expectancy and goals of care are exclusively to optimize quality of life and maintain comfort; patient has elected to forego life-prolonging therapies. Source: [113] Table 5 Parkinson disease Amyotrophic lateral sclerosis Multiple sclerosis
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MDCA1525
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