Hospice vs Palliative Care: Why it’s Important You Know What is Similar and What Makes Them Differen
Helping my mom take the badges off her burn wound caused by radiation treatments, I couldn’t help but wonder, why isn’t the medical community helping to relieve my mother’s pain and anxiety of what she was going through. She had Inflammatory Breast Cancer (IBC), a rare cancer that doesn’t have a good prognosis but she insisted on treating her cancer aggressively. I was familiar with hospice care, which assisted my dad in passing comfortably, but my mother was sure she was going to beat this cancer with treatment so she refused hospice. Through her treatments, she fought like a warrior but ultimately succumbed to her cancer. According to GetPalliativeCare.org, many people with a serious terminal or serious illness are hesitant to seek help through hospice or palliative care teams. However, we finally talked her into receiving help, and once on hospice care her pain was under control and she passed peacefully. Some feel that accepting help from a hospice organization is giving up and it wasn’t until my mom passed away that I learned of Palliative Care. Looking back now I wish we knew more about Palliative Medicine, because if we knew my mom’s suffering would have been drastically reduced while battling cancer. Below is more information about the difference and similarities between Palliative Care and Hospice Care.
What does Palliative mean?
According to Meriam-Webster, palliative is to serve to palliate or to reduce the violence of (a disease); also: to ease (symptoms) without curing the underlying disease.
What is Palliative Care?
Many people mistakenly believe you receive palliative care only when you can’t be cured. Palliative care may help you recover from your illness by relieving symptoms—such as pain, anxiety, or loss of appetite—as you undergo sometimes-difficult medical treatments or procedures, such as surgery or chemotherapy.
Palliative medicine is a medical sub-specialty provided by doctors who offer palliative care for people who are seriously ill. Palliative care relieves suffering and improves quality of life for people of any age and at any stage in a serious illness, whether that illness is curable, chronic, or life-threatening.
Palliative care is whole-person care that relieves symptoms of a disease or disorder, regardless if the disease is curable or not. Hospice is a specific type of palliative care for people who likely have 6 months or less to live. In other words, hospice care is always palliative, but not all palliative care is hospice care.
Who benefits from palliative care?
Palliative care is a resource for anyone living with a serious illness, such as heart failure, cancer, chronic obstructive pulmonary disease, Parkinson’s disease, dementia, plus a whole host of other life limiting illnesses. Palliative care can assist at any stage of illness and is best provided from the point of diagnosis. Primary doctors help cure the disease, palliative care practitioners help to relieve the symptoms of the disease or treatment making the journey to health or end-of-life more manageable.
In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to anyone having a lot of general discomfort and disability. Palliative care can be provided along with curative treatment and does not depend on prognosis.
Understanding Palliative Medicine
Team-Based Philosophy
A palliative care consultation team is a multidisciplinary team that works with the patient, family, and the patient’s other doctors to provide medical, social, emotional, and practical support. The team is made of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, massage therapists, and chaplains.
The team focuses on patient-centered care and comfort for the Whole Person, the physical, emotional and spiritual needs of an individual.
Hospice Care
Hospice care is under the palliative umbrella because patient-centered care and comfort are still the focus of the team, but some point, it may not be possible to cure a serious illness, or a patient may choose not to undergo certain treatments. Hospice is designed for this situation. The patient beginning hospice care understands that his or her illness is not responding to medical attempts to cure it or to slow the disease’s progress.
Hospice is an approach to care, so it is not tied to a specific place. It can be offered in two types of settings—at home or in a facility such as a nursing home, hospital, or even in a separate hospice center.
Hospice care brings together a team of people with special skills—among them nurses, doctors, social workers, spiritual advisers, and trained volunteers. Everyone works together with the person who is dying, the caregiver, and/or the family to provide the medical, emotional, and spiritual support needed.
A member of the hospice team visits regularly, and someone is always available by phone—24 hours a day, 7 days a week. Hospice may be covered by Medicare and other insurance companies.
Massage Therapists as Part of the Interdisciplinary Palliative Care Team
The Massage Therapists Role
Individuals in hospice and palliative care settings almost always dealing with a variety of issues, pain, anxiety, stiffness, depression and the stress of dealing with their disease. Research into massage seems to point to multiple benefits for reducing the symptoms these patients deal with daily.
In August of 2017, the AMTA published an article on massage in palliative care. They focused on multiple studies about the effect of massage on palliative patients. A 2014 study focused on integrating massage therapy into palliative care found statistically significant changes in pain, anxiety, relaxation and inner peace of patients, decreasing both pain intensity and anxiety while increasing the patients’ sense of relaxation and inner peace.
In 2013, research published in Complementary Therapies in Clinical Practice showed that adults with rheumatoid arthritis may feel a decrease in pain, as well as greater range of motion in wrists and large upper joints, after receiving regular moderate pressure massage during a four-week period. Additionally, in a 2012 pilot study published in Military Medicine, veterans indicated significant reductions in ratings of anxiety, worry, depression and physical pain after a massage.
More recently, a 2016 collaborative meta-analysis of research on massage therapy for pain—conducted by Samueli Institute and commissioned by the Massage Therapy Foundation with support from the American Massage Therapy Association—found that, based on the evidence, massage therapy shows promise for reducing pain intensity/severity, fatigue and anxiety in cancer populations when compared to active comparators.
At Heart Touch, we have found the individual attention and mindful touch each practitioner brings to the bedside only enhances the effects of the touch. Connection and being fully present with a patient provides the added connection that is often needed by a patient dealing with a life-limiting illness.
Massage vs Gentle/Comfort touch
One of the distinctions we make in our Heart Touch trainings is the difference between massage and gentle or comfort Touch. We find that a massage therapists touch should be determined by where the patients are at with their disease process. Working with palliative care or end-of -life patients it is crucial to drop a massage routine, the massage therapist must alter his or her touch based on what is happening with the patient that day. Patients conditions can change rapidly as they are dealing with the ups and downs of pain and sometimes side effects of medications or treatments.
All touch for palliative patients must be mindful but we have found as a rule that hospice patients require more of a gentle touch and palliative patients sometimes need more of a massage. So, what is gentle touch vs massage?
Gentle Touch: consists mainly of some slow movements and resting of hands on the patient's body
Massage Therapy: traditional manual therapy is soft tissue manipulation for the intent of therapeutic change
The benefits of a Heart Touch trained massage therapist are that the therapists bring a knowledge of the patient’s condition along with a mindfulness through touch to the session.
If you are interested in this work and would like to know more about it, please feel free to contact me at camille@heartttouch.org.
