People often misconstrue death and dying as an unnatural phase of life. Consequently, many people suffering from terminal illnesses become neglected, or worse, treated as dead even when they are still alive and breathing.
A dying individual is more than just a patient with symptoms to be controlled and treated. Care for a person must be holistic in its approach when addressing their physical, psychological, social, and legal needs. This article aims to provide suggestions and recommendations for high-quality care services for people with serious illnesses.
Palliative vs. Hospice Care: What's the difference?
Both the medical and lay communities commonly use the phrases "hospice" and "palliative care" interchangeably to indicate that a patient is nearing death. The prognosis is usually six months or less. There is also the notion that palliative care is primarily centered on pain alleviation, whereas hospice care is generally associated with death and bereavement support.
The interchangeable use of terminologies frequently leads to misunderstanding and a reluctance to accept or seek such services.
What is Palliative Care?
Palliative care might sound distressing to some people. It's frequently associated with end-of-life care. If your doctor refers you for palliative care, it doesn't mean they've given up on you or that you have to stop receiving treatments for your condition. In essence, palliative care isn't about dying— it's about living. Given the rising death toll and its implications for palliative care, the World Health Organization (WHO), in 1982, amended that palliative care is an approach to care intended to improve a patient’s quality of life while facing life-threatening illness.
This definition broadens the concept of palliative care beyond end-of-life, implying that such approaches can be integrated with life-sustaining therapy in managing illness. The new W.H.O. definition also emphasizes the quality of life rather than the quantity and longevity. It affirms that dying is a normal part of the cycle of life.
What is the Goal of Palliative Care?
The main goal in palliative care is to provide relief from pain and other distressing symptoms. It also aims to provide psychosocial and spiritual support. This is all through a multidisciplinary team of physicians, nurses, social workers, chaplains, and nutritionists. Palliative care also aims to affirm life and regard dying as a normal process.
It intends not to hasten or postpone death but to enhance the quality of life, positively influence the course of illness, and offer a support system to help patients live as actively as possible.
Who Qualifies for Palliative Care?
To be eligible for palliative care, an individual must have either of the following:
- Serious or incurable illness that significantly limits the quality of life. According to WHO, most adults in need of palliative care have chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS, and diabetes.
- Severe and uncontrolled symptoms. Difficulty in breathing and pain are two of the most frequent and pressing symptoms of patients with progressive conditions. While there may be no curative management for illnesses such as cancer and AIDS, palliative care focuses on lessening and controlling these symptoms.
A referral from a healthcare provider is needed. The primary care physician usually gives the referral, but a specialist for your illness or any physician acquainted with your condition can also provide it.
What Is Hospice Care?
Palliative care may transition to hospice care near the end of life. Hospice care provides end-of-life therapy to patients with terminal illnesses that focuses on the patients’ comfort and quality of life rather than the cure. When comparing concepts between hospice and palliative care, the former can be best described as intensified palliative care for individuals approaching death.
It requires collaboration with a team of professionals, the patient, and the family to assist the patient to live as comfortably as possible through the dying process.
Who Qualifies for Hospice Care?
Patients are eligible for hospice care in the final phase of a terminal illness or incurable disease, usually the last six months of life.
How Can I Receive Palliative and Hospice Care?
To date, there are around 44 organizations focused on providing palliative and hospice care among those with chronic and life-limiting illnesses in our country, especially those underprivileged. As described in Section 2 of The Universal Health Care Act (Republic Act No. 11223), all Filipinos should have access to the full spectrum of health care which includes preventive, curative, rehabilitative, and palliative care, while prioritizing the needs of the population who cannot afford such services.
A PhilHealth ID is no longer required to receive these services. Impoverished Filipinos and those living in geographically distant locations will be prioritized when acquiring healthcare services. Palliative care services are usually offered in hospitals. However, people can also acquire them in various settings, including clinics, local health centers, and outpatient facilities.
Palliative care can also be given at home since supportive programs are often tied with home care services, given that most Filipinos prefer to care for their ailing family members or delegate the care to someone they know.
Because hospice is a philosophy of care, the services can also be provided at home, in freestanding hospice facilities, in nursing homes, extended care, or acute care settings. Many chronically ill people prefer to stay at home to obtain hospice care during the final stages of their illness to prepare for death in familiar surroundings, alongside family and friends. A person is eligible for home care if the physical surroundings are deemed adequate and safe.
Once the patient can receive home care, the facility may deliver medical supplies and individualized equipment to the client. Health professionals may do telemedicine or consultations by phone if routine visitation is impractical.
Palliative and Hospice Care in The Philippines
The Filipino perspective on death and dying is driven by religious ideals, beliefs, culture, and family. In Philippine society, the family is central and carries significant importance, especially in making healthcare decisions. Families, traditionally, are actively involved in caring for their dying loved ones, and healthcare providers are expected to do the same.
These providers are the ones who make up the team of palliative and hospice care professionals who continuously try to improve their patients' quality of life and provide them with dignity until their dying moment.
Facilities and Resources in the Country
The movement towards the development of palliative and hospice care in the Philippines began in the 1980s, gaining a foothold due to collaborations across various sectors of society. However, in 2000, funding for palliative care was greatly reduced when the government realigned its priorities. The increasing prevalence of incurable, debilitating, and life-limiting illnesses highlights the curative aspects of medicine, active management of chronic conditions, and even aggressive treatment of life-threatening diseases.
Consequently, resources from multiple sectors tend to focus in such direction and may downplay the "Care" aspect, an equally important health management component.
According to the Global Directory Of Palliative Care Institutions And Organizations, most of the 44 palliative and hospice care groups currently providing end-of-life care to Filipinos are located in densely populated urban regions. Despite training and a long history of palliative care development in the Philippines, many challenges are still present, resulting in futile and burden-some care. These include health inequalities and poor efforts among the stakeholders in implementing palliative and hospice care services, as well as unawareness of healthcare professionals about the necessity of palliative care, impaired health and medication literacy among patients, and the stark reality that the existing palliative and hospice care organizations are continuously challenged with the enormous need for manpower and funding.
When a loved one is diagnosed with a terminal illness, it can be difficult to discuss end-of-life choices. Hospice and palliative care differ significantly from standard care provided at hospitals and other medical facilities. Through this philosophy of care, health professionals take on a comprehensive approach to assure that both the patient’s and the family’s needs are attended to.
They give patients and their families the opportunity to spend their final days together in a compassionate environment that intends to make the patient as comfortable as possible while also assisting their families in coping with the dying process and aftermath.
“Those who have the strength and the love to sit with a dying patient in the silence that goes beyond words will know that the moment is neither frightening nor painful, but a peaceful cessation of the functioning of the body… Watching a peaceful death of a human being reminds us of a falling star; one of a million lights in a vast sky that flares up for a brief moment only to disappear into the endless night forever… it makes us aware of our finiteness, our limited lifespan. - Elisabeth Kübler-Ross
Other Resources
Directory of Palliative and Hospice Facilities and Organizations
Palliative Care Guidelines During the COVID-19 Pandemic
Sources
Global Directory of Palliative Care Institutions and Organizations. International Association for Hospice & Palliative Care, 2020. https://hospicecare.com/global-directory-of-providers-organizations/search/?idcountry=53.
Connor, S.R. Hospice and Palliative Care: The Essential Guide, Second Edition. Journal of Social Work in End-Of-Life & Palliative Care, 2012. https://www.tandfonline.com/doi/abs/10.1080/15524256.2012.650722.
World Health Organization: WHO. Palliative Care. World Health Organization, November 13, 2019. https://www.who.int/health-topics/palliative-care.
Implementing Rules and Regulations of the Universal Health Care Act (Republic Act No. 11223), n.d. https://www.philhealth.gov.ph/about_us/UHC-IRR_Signed.pdf.
Hospice Groups. Philcancer.org.ph, 2012. http://www.philcancer.org.ph/support/hospice-groups/.
PSPHP Secretariat. Three-Part Guidance Documents for Palliative Care of Patients Including Those with Life-Threatening Illness - Philippine Society of Public Health Physicians. Philippine Society of Public Health Physicians, May 8, 2020. http://psphp.org/2020/05/three-part-guidance-documents-for-palliative-care-of-patients-including-those-with-life-threatening-illness/.
Minerva, M., Silbermann, M. Current Challenges and Evolving Strategies in Implementing Cancer and Palliative Care Services in The... ResearchGate. unknown, March 8, 2019. https://www.researchgate.net/publication/332698708_Current_Challenges_and_Evolving_Strategies_in_Implementing_Cancer_and_Palliative_Care_Services_in_the_Philippines.
