Palliative, End-of-Life and Survivorship Care
Core concepts
Palliative care improves quality of life alongside curative treatment; hospice care is for people with a limited prognosis who forgo disease-directed therapy. Know symptom management at end of life (pain, dyspnea, secretions, agitation, anorexia), advance care planning, and the difference between withdrawing and withholding treatment. Survivorship care includes surveillance, late effects (cardiotoxicity, neuropathy, secondary malignancy, fertility), health promotion, and care plans.
Traps in questions
- Palliative is not hospice: palliative care can begin at diagnosis.
- Opioids at end of life are titrated to comfort; respiratory depression concern must be weighed against untreated suffering.
- Withdrawing treatment is ethically equivalent to withholding when consistent with patient wishes.
- Late effects are time-dependent: anthracycline cardiotoxicity and radiation effects can appear years later.
- Survivorship is not the end of care: surveillance and health promotion continue.
Rule of thumb
Ask what the patient values, then match treatment to those values. If an option imposes the clinician's values, it is wrong.
Worked example
A patient with advanced cancer asks about stopping chemotherapy to focus on family time. The nurse supports this as a legitimate goals-of-care decision, explores symptom needs, and coordinates palliative care and advance care planning - not persuasion to continue.