Meaning and Practice of Palliative Care for Hospitalized Older Adults with Life Limiting Illnesses

Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses. 1. Introduction The fields of palliative and end-of-life care are plagued by semantic confusion. The confusion has resulted in conflation of these concepts around concerns about death and dying that limit understanding of their distinct and synergistic properties. This paper illustrates the distinctions between as well as the intersections of palliative care (PC) and services exclusively devoted to end-of-life (EOL) care, such as hospice. The illustrations are from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital PC consultation service. We do not view institutionally based PC and hospice services as synonymous. PC services may be provided at any time along the illness trajectory and may be delivered at the same time as curative treatments. In contrast, organized hospice services generally involve provision of PC focused exclusively on comfort care of persons identified as having a short life expectancy (usually six months or less) and who are no longer seeking disease-directed treatments. To be enrolled in hospice, patients and families must make the difficult transition to accepting that they are entering the end stage of life and that medical treatments to prolong life are no longer feasible. PC services include managing pain and other physical symptoms, improving quality of life, providing psychosocial, emotional, and spiritual support, dealing with uncertainty about treatment options and goals of care, and, through communication