ThedaCare Health Matters

End-of-Life Care focuses on quality, not cure

This past week, I was reminded of the challenges of caring for people at the end of life. I traveled to visit two relatives on my wife’s side of the family who lived far away. I had not seen them for quite some time and I was the primarily driver responsible for getting my wife and mother-in-law to the destination.

One relative was just diagnosed with advanced cancer and was still trying to understand the diagnosis and the implications. The other has chronic dementia that has progressed to the point that she was no longer able to communicate and could not live at home. I have dealt with situations like this many times in patients I have cared for, but this was different in that I was an observer and not able to direct the care plans. It reminded me how complicated and challenging end of life care can be.

Health care seems to focus on the physical aspects of patient care. Symptoms or findings lead to testing and procedures that try to diagnose and treat physical problems. Providers and patients hope for diagnosis that can be treated and cured. Unfortunately, there are conditions that are not curable, but that does not mean they cannot be treated. For those patients with incurable problems in the advanced stages, the focus optimally is changed to “What can be done to improve this person’s quality of life?”

When discussing end of life care, generally there are two categories. One scenario would be the situation where there is a progressive, incurable disease process with a defined limited life expectancy.

An example of this is metastatic cancer that is not responsive to treatment. This would be the scenario when hospice care would be appropriate. Hospice care provides comfort measures. The other category would be care of someone with an incurable problem that causes severe debility. An example of this is advanced dementia. The care that can be provided is referred to as palliative care as it focuses on comfort measures (similar to hospice care), but may go on for years.

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