[@PeterAttiaMD] The Difference Between Palliative and Hospice Care | with BJ Miller, M.D. & Bridget Sumer, L.C.S.W.

Link: https://youtu.be/2_di2UOiyKI

Short Summary

Number One Action Item/Takeaway:

Consider palliative care earlier in the course of serious illness, rather than waiting until the very end of life to focus on quality of life.

Executive Summary:

Palliative care, a broader umbrella than hospice, focuses on improving quality of life for individuals facing serious illness, regardless of prognosis or ongoing curative treatments. Hospice, a subset of palliative care, is for individuals with a life expectancy of six months or less who are no longer pursuing curative treatments. Individuals often wait too long to consider hospice, potentially experiencing unnecessary discomfort and suffering.

Key Quotes

Here are five direct quotes from the transcript that I found particularly insightful:

1. "No matter how you slice it the goal is is the focus is quality of life. Yep. Period. Whether it's p of care or hospice." - This quote encapsulates the core principle guiding both palliative and hospice care.
2. "...as possible as defined by them." - This highlights the personalized nature of palliative and hospice care, acknowledging that quality of life is subjective and unique to each individual.
3. "When you go onto hospice, you have to give up that curative intended care..." - This clarifies a crucial distinction between palliative and hospice care, emphasizing the shift in focus from treatment to comfort.
4. "So it's very often that the physicians don't bring up hospice until way late in the game. So for many reasons, I think it is a generally true statement that we wait too long to in uh invoke hospice. We wait too long based based on our own stated goals of feeling at peace and having some comfort towards the end and not wasting our time doing things that don't help us." - This quote acknowledges how the late initiation of hospice care has caused discomfort by pursuing therapeutic treatments longer than helpful.
5. "Pal of care those are neither of those applies for pal of care. So that's a really important distinction. So I'm trying to kind of and one other point to make there is while pal of care is the larger umbrella hospice is the older one." This quotes provide key differences and origins between hospice and paliotative care to help the audience understand the wonky history.

Detailed Summary

Here's a detailed summary of the YouTube video transcript, focusing on the key topics, arguments, and information discussed:

• Palliative Care vs. Hospice Care: The Big Picture

  • Palliative care is a broad umbrella, a medical specialty focused on quality of life for people with serious illnesses.
  • Hospice care is a subset of palliative care, generally focusing on the final months of life. Think of it as the "back end" of the palliative care umbrella.

• Palliative Care: Focus and Objectives

  • No limitations on disease-directed or modifying therapies.
  • Patient does not have to be imminently dying or facing death.
  • Objective: Holistic approach centered on the individual's life, circumstances, understanding of illness, and support system.
  • Goal: Help the person feel as well as possible, treating symptoms related to the illness and its treatments, while considering their overall life context.
  • Quality of life is paramount, as defined by the individual.
  • Interdisciplinary approach is essential: Doctors, social workers, chaplains, nurses, music therapists, art therapists, volunteers, etc.

• Defining "As Well As Possible":

  • Highly individual.
  • Could mean aggressive pain management for one person, or prioritizing relational/concrete supports for another.
  • The focus is on meeting the person in their current moment and identifying what's most important to them.

• Transition from Palliative Care to Hospice Care

  • Ideal transition vs. reality: In the US, people are often admitted to hospice very late, with an average stay of around 3 weeks.
  • Hospice as a good fit when:
    • The patient wants to stay out of the hospital.
    • The patient is grappling with the reality that treatments are no longer changing the course of their disease.
    • The patient is ready to be supported in their end-of-life transition.
    • The patient is done with pursuing further treatments.

• Hospice Care Delivery Options

  • Hospice in the home (team comes to the patient).
  • Palliative care ward inside a hospital providing hospice care.
  • Outpatient hospice facilities (dedicated facilities, not hospitals).

• Key Distinctions Between Palliative Care and Hospice Care (Policy and Insurance)

  • Palliative care can be provided alongside curative-intended care.
  • Hospice care requires foregoing curative-intended care.
  • On hospice, you generally cannot have IV lines.
  • To qualify for hospice, a physician must certify that the patient likely has six months or less to live if the disease runs its course.

• Historical Context:

  • Hospice care is actually older than formal palliative care in the US.
  • Hospice began with Medicare in 1982, with specific restrictions.
  • Palliative care emerged later to provide similar loving care without the restrictions of hospice.

• Problem: Late Hospice Enrollment

  • The average length of stay in hospice (3 weeks) suggests patients may be enrolling far too late, potentially causing unnecessary discomfort.
  • With 3 weeks left of life, the patient is often already in delirium, organ failure, and spending most of their time sleeping.

• Why the Delay?

  • Patients/families may be in denial or not ready to confront the reality of the situation.
  • Referring physicians may not recognize the signs or be reluctant to discuss hospice early enough.
  • This leads to patients potentially suffering more, undergoing treatments that are no longer effective, and not achieving their desired end-of-life goals (peace, comfort).