By RICK WEBER
Palliative care and hospice are not exactly the same and are not a “death sentence,” but rather a way of establishing hope and comfort in a difficult time—whether or not it is the last phases of a disease process.
“The ‘death sentence’ myth is one I have spent much of my career working alongside others to dispel,” says Julie Furrow, PhD, APRN, FNP-BC, CNE, ACHPN, an assistant professor in the Marieb College of Health & Human Services’ School of Nursing at Florida Gulf Coast University.
“I am passionate about this because those who buy into the myth are at risk for declining services that may be extremely beneficial to them. One of the hardest truths to face in life is that no matter how far medical science and technology have come, there eventually comes a time when medicine can no longer prevent the end of life. In fact, technology and life-prolonging measures can cause discomfort that some patients prefer to avoid. Many illnesses ultimately lead to death, while some people reach that point simply through the natural aging process. One way or another, death is an inevitable part of the human experience.”
Palliative care and hospice exist to support people as they face serious illness and, ultimately, the end of life.
Palliative care is a broader service that can start much earlier in a disease process as compared to hospice. Palliative care exists not only for alleviation of pain and symptoms, but also to begin conversations with patients with serious or potentially life-threatening illnesses. Palliative care providers spend time discussing disease trajectories, exploring treatment options and exploring the meaning of these things to the patient experiencing them.
“There is no such thing as a ‘one-size-fits-all’ approach to healthcare, especially when a serious illness is involved,” Furrow says. “It is a privilege to meet patients and their families, learn what is most important to them and walk with them and support them as they make the complicated health care choices that make the most sense to them and best fit their goals, preferences and values.
“In addition to goals of care, palliative care providers assist in completion of advanced directives. One of the most important things an adult can do is leave their loved ones with instructions including who should become their decision maker(s) if/when the individual is unable to speak for themselves. This is important for all adults, but even more so for those diagnosed with progressive and life-limiting illnesses.
“Advanced directive documents can also include living wills, which guide health care providers and loved ones in what the individual would want in certain situations such as dependence on machines for breathing or dependence on artificial nutrition for living. Patients can receive palliative care concurrently with ‘aggressive’ disease-fighting care. For example, a patient receiving anti-cancer therapy, such as chemotherapy and radiation, can receive palliative care to discuss their goals and treatment options, and to receive pain and symptom management.”
Hospice is a palliative service that provides care to patients specifically in the last months of life when life-extending treatment is either no longer an option—because it is not working or because the patient is not tolerating it—or no longer desired by the patient. Hospice care is most often provided in the home, wherever home may be. This can include a private residence, long-term care facility and even prison.
Hospice focuses fully on the patient’s comfort, stopping diagnostic testing, treatments and medications that are no longer beneficial to the patient. Hospice providers are highly specialized and skilled in assessing and assisting with management of discomfort in all facets including the physical, psychological, emotional, spiritual and social aspects of life.
These services focus on providing comfort, enhancing quality of life and easing the fear that often accompanies this stage. Hospice offers an option to step away from aggressive diagnostic testing and life-prolonging treatments when they no longer provide benefit or when a patient chooses a more comfort-focused approach to care.
“It’s important to understand that neither palliative care nor hospice is meant to hasten death,” Furrow says. “Equally important is the recognition that whatever path a patient chooses, whether pursuing continued life-prolonging treatment or focusing on comfort, should be fully honored and respected by those providing care.”
Furrow’s first research activity in this field was her master’s thesis in 2003, when she was a hospice nurse interested in learning more about barriers to patients receiving hospice and palliative care. She collaborated with the West Virginia Center for End-of-Life Care to conduct research on health care providers’ knowledge and attitudes about palliative care. Findings pointed to an ongoing need for healthcare provider education in end-of-life care in her region in West Virginia.
Then, doing her doctoral dissertation in 2016, she studied use of human standardized patients in the simulation lab as a method of teaching nursing students to provide patient education.
“I believe this could be modified to teach nursing students to converse with patients and families facing serious illness,” she says. “I see potential to conduct future research in this area.”
Furrow recently passed her national board exam as an advanced practice palliative provider—an important step in her relationship with her FGCU students.
“Educators teach nursing students that certification is an important way to deepen their competence within their chosen specialties and to ensure they’re providing the highest quality of care,” Furrow says. “I use my own experience as an example to show them what’s possible in their future careers and to demonstrate that I don’t just encourage certification—I actively pursue it myself. The studies and experience required to earn my certification as an Advanced Certified Hospice and Palliative Nurse have given me the expertise to share this vital area of care with the next generation of nurses.”
FGCU
Marieb College of Health & Human Services
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Fort Myers, FL 33965
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