Author(s): Robert Arnold, MD and David E. Weissman, MD

 Palliative care consultative services are becoming commonplace in academic and community hospitals. Patients and families often, although not always, have negative perceptions of palliative care and hospice, viewing such a discussion as signaling that the physician is “giving up on the patient” and that the reality of impending death must be faced. This Tip Sheet provides ideas for beginning a discussion leading to a visit by a palliative care consultation team.

First, decide why you want assistance from the palliative care team; typically, physicians seek assistance in four domains: 1) pain and non-pain symptom assessment and management; 2) assistance in making difficult decisions, usually about continued use or withdrawal of technological treatments such as feeding tubes, antibiotics, dialysis, or ventilators; 3) assistance in planning for the most appropriate care setting and care givers to meet patient/family goals for end-of-life care; and 4) providing psychological support to patients, families and the health care team.

Second, contact the palliative care team.  Describe both what your goals are for the consultation, as well as what the family’s/patient’s goals may be. This is a good time to discuss any concerns you have about using the term palliative care with the patient or family.

Third, engage the patient/family in a discussion of the current medical condition and goals of care.  Introduce the topic of a consultation by saying: To best meet some of the goals we’ve been discussing (fill in with the goals mentioned by the family/patient) I’d like to have some consultants from the Palliative Care Team visit with you. You can follow this by saying, They are experts in treating the symptoms you are experiencing (fill in symptom); They are also good at helping your family deal with all the changes brought on by your illness; they can answer your questions about (fill in previously discussed patient questions).

Talk about the positive goals Palliative care can help you and the patient achieve.

Finally, emphasize your continued involvement: You and I will talk about the recommendations of the palliative care experts. I'll make sure all your questions are answered. This can help relieve fears of abandonment. If a patient or family reacts negatively to the suggestion for a consultation, you might explore their concerns. Someone may have mentioned palliative care and this may have negative connotations to them.  It may be important to discuss that palliative care is compatible with aggressively treating the underlying disease.   The goal of palliative care is to achieve the best possible quality of life through relief of suffering, control of symptoms and restoration of functional capacity, while remaining sensitive to the patient and family’s value. Palliative care guides the patient and family as they face disease progression and changing goals of care, and helps those who wish to address issues of life completion and life closure.

References: Weissman , DE . Consultation in Palliative Medicine. Archives in Internal Medicine. 1997: 157:733-737.

Precepts of Palliative Care. Last Acts Campaign Task Force on Palliative Care. J Pall Med 1998; 1; 109-115

Medical College of Wisconsin Palliative Care Center:   www.mcw.edu/palliativecare.htm

Hospice and Palliative Nurses Association:   www.hpna.org

National Hospice and Palliative Care Organization:   www.nhpco.org