“Many Primary Care Clinicians Provide Palliative Care without Realizing It”

Physician Bulletins: Below, you will find a sample of the community-based healthcare utilization bulletins that we routinely mail to referring doctors and other healthcare professionals.

Writing for the Mayo Clinic in an article published last year, Mary K Buss, MD, MPH made an interesting observation: “Many PCPs already engage in primary palliative care but may not recognize their actions as palliative care.”¹ In fact, general practitioners, not hospice or specialists, provide most palliative care. Palliative medicine grew out of the hospice movement and was recognized as its own medical subspecialty along with hospice in 2006. This fact leads many to conflate palliative care, hospice, and end-of-life care. All hospice is palliative, but not all palliative medicine is hospice. To appreciate the difference between palliative care and hospice, consider the definition of palliative care offered by the Center to Advance Palliative Care: ²

“Palliative care is specialized medical care for people with serious illness. It focuses on provid-ing relief from the symptoms and stress of serious illness (whatever the diagnosis). The goal is to improve quality of life for both the patient and the family.”
Palliative care commonly provided by general practitioners includes: 

• Prognostication
• Helping patients understand their prognoses, as patient recall and understanding of prognosis conver-sations is often very limited
• Helping patients articulate their goals of care
• Careful symptom assessment with recognition of how the symptoms impact individual quality of life
• Prescribe and titrating opioids for pain management
• Other symptom management
• Referral to specialists and community-based providers as needed
• Helping patients and their families find value and meaning, especially when a patient’s time or functioning is limited
• Promoting each patient’s ability to remain active in important activities and relationships
• Bereavement support

If the majority of palliative care can occur in the outpatient, general practice setting, this begs the question “What’s hospice for?” Hospice can provide that same palliative care and more when your patient needs visit lengths or a number of encounters that no longer fit the outpatient model. For instance, hospice can send nurses multiple times per week and have a nurse on call 24/7 to prevent unnecessary/unwanted emergency department trips. Add this to the regular visits of home aides, volunteers, social workers, the chaplain, and more, and it’s easy to see how hospice can fill needs that have become more intensive. Receiving palliative care at home increases rest and convenience for patients. Additionally, although most patients prefer to die at home, only 25% of Americans have this wish met. Hospice supports patient preferences with 75% of hospice patients having this wish honored.

Hospice Equipment in as Little as Two Hours

When patients go home with hospice, they don’t want to wait days for needed medical equipment such as beds, bedside commodes, or home I.V. equipment. Send your hospice referrals to Avatar to ensure your patients receive their medical equipment as fast as possible – often within two hours of your refer-ral.

Please offer Avatar Home Heath to Your Patients

Contact Avatar Home Health 

1. Buss MK, Rock LK, McCarthy EP. Understanding Palliative Care and Hospice: A Re-view for Primary Care Providers. Mayo Clinic Proceedings. 2017 Feb 28; (Vol. 92, No. 2, pp. 280-286). Elsevier.
2. Lupu D, Force PM. Estimate of current hospice and palliative medicine physician work-force shortage. Journal of Pain and Symptom Management. 2010 Dec 31;40(6):899-911.