What kinds of treatment focus on symptom relief and comfort at the end of life?
Hospice care is a comprehensive program that includes
palliative care to help manage symptoms (such as pain)
at the end of life. This kind of care focuses on improving quality of life when
treatment to cure a serious illness or prolong your life is no longer
realistic. For more information on this type of care, see the topic
Palliative Care. Doctors and other health care workers
involved with hospice help you identify your treatment choices, identify goals
for the end of your life, and offer emotional and spiritual resources if you
wish to pursue them.
Hospice programs also support loved ones involved in your care by
offering services such as home visits, breaks for caregivers (respite care),
and grief counseling.
When you start a hospice program, you usually agree to end all
life-prolonging treatments and to focus completely on your comfort, quality of
life, and symptom relief. However, the decision to not use other treatments
does not have to be permanent. Although you usually must leave hospice care to
pursue other treatments, you may rejoin the program at a later time. You may
even be able to pursue life-prolonging treatments while in a hospice care
Relieving your physical symptoms
Palliative care at the end of life attempts to control many of
the symptoms associated with serious illness and the dying process. Palliative
care sometimes can be combined with life-prolonging treatment. However, at some
point, treatments aimed at prolonging your life may detract from the palliative
focus on comfort and quality of life. You may decide that treatments designed
to prolong your life are more likely to add pain and will not prolong your life
in a meaningful way.
If you choose to focus completely on palliative care, your doctor
will concentrate on relieving your symptoms such as pain, nausea, shortness of
breath, fever, and loss of appetite. In order to help keep you comfortable,
your doctor will ask you to describe your symptoms. Questions may
- Are you having pain, nausea, or both? Do you
have more than one pain? Is your pain sharp or dull? What other symptoms are
- Where do you feel pain or other symptoms? For example,
are you having pain in your abdomen or throughout your body?
do your symptoms usually occur? For example, if you are having shortness of
breath, does it happen after activity? Is it constant?
- What makes
your symptoms worse? Activity may make your pain worse, as may sitting in one
position for a long time.
- What makes your symptoms better? Rest?
Taking your pain medication routinely?
Describe your symptoms as clearly as you can. You may find it
helpful to keep a diary or chart of your symptoms so that you can discuss
concerns with your doctor.
Estimating your prognosis
An important aspect in choosing your medical care at the end of
life involves making a reasonable attempt to estimate your prognosis, the
amount of time you have left to live. Your prognosis will help you and your
doctor evaluate the appropriateness of certain medical treatments. For
instance, if your doctor feels you have several months to years to live,
certain medical therapies may help you maintain comfort and improve the quality
of your remaining days. On the other hand, if you are expected to live for only
a few weeks, certain medical treatments, such as surgery, may cause more pain
and side effects than you are willing to endure.
Understanding your prognosis is important to help you and your
family prepare for dying. Having a sense of how much time you have to live may
help you to review your life, your accomplishments, and your regrets. It may
also help you to focus on saying good-bye to your family and to nurture or
Although it is sometimes difficult for doctors to estimate
prognosis, you should expect clear and sensitive answers to your questions. It
may be helpful to see another physician for a second medical opinion when
prognosis is not clear.
Identifying your treatment goals
As the end of life nears, your doctor will help you identify your
treatment goals and make sure your medical care fits in with your preferences.
This communication may help you decide whether you want to continue with or
stop receiving life-prolonging treatment. For example, while talking about your
treatment options with your doctor, you may discover that your only wish is to
keep your pain at a tolerable level. Or you may identify several goals, such as
staying active as long as possible and living to see a child graduate from
college, that point more toward pursuing or continuing with life-prolonging
Managing your practical, emotional, and spiritual needs
It is normal to experience a wide range of emotional and
spiritual issues as death approaches. For example, you may have concerns about
how to manage your finances or worry about how your condition affects your
Regardless of the focus of your treatment, whether it be on
life-prolonging treatments or on those to relieve symptoms and keep you
comfortable, many resources are available to help you address personal issues.
The difference may be in ease of finding and getting help.
If you continue with life-prolonging treatments, you may need to
be proactive with your doctor and other health professionals. Ask about a
support group for people with a life-limiting disease. Find out about
psychologists or psychiatrists that specialize in end of life issues. Contact
or seek a financial counselor to help manage your accounts. You may also want
to explore issues about the meaning and purpose of your life, in which case a
spiritual advisor, a family member, or a friend may help.
If you enroll in
hospice care, most of these services are easily
accessed because they are offered or addressed as part of the program. Also,
additional services usually are available, such as grief counseling for family
What are the benefits of stopping life-prolonging treatment and focusing on symptom relief and comfort?
Medical care focused on keeping you comfortable and providing you
with the highest quality of life possible until your death occurs, such as
hospice care, helps relieve your suffering with
palliative care. For many people, this quality-of-life
focus allows time and energy to be spent on emotional and spiritual needs at
the end of life. Also, services can be pursued to support the needs of your
family, friends, and/or caregivers.
Care focused on symptom relief and quality of life often involves
the support of several health professionals, such as a hospice team. Some of
these caregivers can offer resources to help you address difficult emotional
issues, such as broken relationships, financial issues, or a fear of dying.
Although challenging, facing these issues usually will help you and your family
What are the risks of stopping life-prolonging treatment and focusing on symptom relief and comfort?
You may fear that you will not receive the best available medical
treatment if you stop pursuing treatments that prolong your life or attempt to
cure your condition or slow its progression. Focusing on pain relief and
symptom management does not mean that you will not have access to your doctor
or to excellent care. Your doctor still cares about you and your illness and
will not abandon you because you have decided to focus on comfort. Also,
curative treatment or treatment to prolong your life remain options. If your
condition changes, you can shift back to curative types of treatments.
What are the risks of continuing with life-prolonging treatment?
Choosing to continue with treatments aimed at prolonging your
life may present several problems.
If communication is not clear between you and your loved ones and
your doctor, and in the event you cannot communicate your wishes, your doctor
and loved ones may choose medical treatment that does not follow your wishes.
If you choose hospice care rather than life-prolonging treatment, your personal
wishes are discussed and communicated clearly to your loved ones and health
Although medical treatment focuses on prolonging your life, you
may miss the opportunity to enjoy valuable time with friends and family because
your treatment may take up most of your energy. You may also experience
negative side effects from life-prolonging treatment. This can interfere with
your quality of life and your ability to spend time with loved ones.
You may not have easy access to support services and financial
resources for you and your loved ones, such as those provided through hospice,
while you receive life-prolonging treatment. For example, you may not be
eligible for programs included in the
Medicare hospice benefit or supported by some private
insurance, such as respite care, which gives family members a break who
routinely care for you at home.
If you need more information, see the topic
Care at the End of Life or