Palliative and End-of-Life Care
Core concepts
Palliative care is comfort and quality-of-life focused care for serious illness at any stage, distinct from hospice, which is for a prognosis of about six months or less and foregoes curative-intent treatment. Know advance care planning concepts: living wills, durable power of attorney for health care, POLST/MOLST, and code status. Understand symptom management: pain (opioids titrated to comfort), dyspnea, nausea, constipation, and terminal secretions. Recognize the difference between withdrawing and withholding treatment-ethically equivalent. Discuss goals-of-care conversations, prognostic communication, and the dying process (decreased intake, Cheyne-Stokes breathing, mottling). Address caregiver support and grief.
Traps
Questions test whether you clarify goals and provide comfort rather than pursue futile interventions. A trap is confusing palliative care with hospice (palliative care can coexist with curative treatment). Another is treating terminal symptoms inadequately due to opioid fears, or failing to recognize that withdrawing a treatment is ethically permissible.
Rule of thumb
When goals are comfort, treat the symptom-and remember that withdrawing and withholding life-sustaining treatment are ethically equivalent.
Worked example
A dying patient with advanced cancer has severe dyspnea. The best action is to provide comfort-focused symptom relief (e.g., opioids titrated for dyspnea) and support the family, consistent with comfort goals-not to initiate aggressive interventions that contradict those goals.