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Upon completion of the chapter, the reader will be able to:

  1. Describe the philosophy of palliative care including hospice care and its impact on medication therapy management.

  2. Discuss the therapeutic management of palliative care patients and how it differs from and is similar to traditional patient care at the end of life.

  3. List the most common symptoms experienced by the terminally ill patient.

  4. Explain the pathophysiology of the common symptoms experienced in the terminally ill patient.

  5. Describe the pharmacologic rationale of medication therapy used for symptom management in the terminally ill patient.

  6. Recommend nonpharmacologic and pharmacologic management of symptoms in a terminally ill patient.

  7. Develop a patient-specific palliative care management plan.

  8. Educate patients and caregivers regarding palliative care management plan, including rationale of treatment, importance of medication adherence, and assessment and monitoring of desired outcomes.


image According to the World Health Organization (WHO), “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” The goal of palliative care is to achieve the best quality of life for patients and their families.1 “Palliate” literally means “to cloak.” The WHO goal of achieving high quality of life depends on a team approach to manage disease-related symptoms while honoring the patient’s goals for care.2 Palliative care focuses on patients and their families and the challenges associated with life-threatening illness.3 The goal is to prevent and relieve suffering by means of early identification, assessment, and treatment of pain and other physical symptoms, including associated psychosocial, emotional, and spiritual concerns.1 Palliative medicine is rapidly becoming a well-recognized medical specialty4 and is much needed due to the increased number of patients with chronic, slowly debilitating diseases.2

The term palliative care is frequently used synonymously with hospice, and although hospice programs provide palliative care, palliative care has a much broader application. In the United States, hospice is defined by Medicare and other third-party payers as a benefit available to individuals who have less than or equal to 6 months life expectancy if the disease runs its typical course.2 Hospice care guidelines and regulations are primarily defined by federal regulations. Palliative care outside of the umbrella of hospice care, in contrast, is not currently regulated nor has the same reimbursement structure. Palliative care services may be provided at any point during the disease process and are not limited to the last 6 months of life; therefore, patients and families may receive palliative care services beginning at the time of diagnosis of life-limiting illness. Palliative care may be delivered in all care settings....

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