Chapter 84: Palliative and End-of-Life Care

The distinction between palliative care, which emphasizes symptom management and quality of life alongside curative treatments, and hospice care, which provides comprehensive support for patients with a prognosis of six months or less, forms a foundational concept for understanding appropriate care transitions. Advance care planning instruments such as My Five Wishes and MOST/POLST orders enable patients to communicate their medical preferences and values before losing decision-making capacity, with terminology like Allow a Natural Death reflecting evolving approaches to sensitive end-of-life discussions. The chapter addresses critical disparities in access and utilization across racial, ethnic, and sexual or gender minority populations, emphasizing the necessity of culturally responsive practice. Primary care providers play an essential role in early identification of functional decline using assessment tools such as the Palliative Performance Scale and Functional Assessment Staging, which guide appropriate timing of referrals. Symptom management represents a cornerstone of this care model, with evidence-based protocols addressing pain management through the WHO analgesic ladder with emphasis on consistent dosing and rescue medications, dyspnea management incorporating opioids and positioning strategies, delirium recognition and treatment, and management of secondary symptoms including excess secretions, nausea, and constipation. Integration of complementary therapies such as music therapy, guided imagery, and acupuncture alongside pharmacological interventions reflects a holistic commitment to alleviating suffering. Throughout all interventions, respect for patient autonomy, spiritual needs, and family-centered care ensures dignity and meaning during the dying process.