Pain management in the terminally ill

Hospice and palliative care

The emergence of AIDS and the aging of the population, with the numerous malignant and debilitating maladies associated with growing older, have focused attention on the provision of cost-effective quality care by hospice and palliative care programs. Hospice and palliative care is a venerated system of care, which uses an interdisciplinary approach to address the medical, psychosocial, and spiritual issues that arise in the treatment of terminally ill patients. This interdisciplinary stratagem for symptom control is necessary to ensure that dying patients and their families are afforded dignity and quality of life through death and the period of familial bereavement. Although death is dominant in palliative situations, terminal care requires an affirmation of life and a recognition that dying is not an aberration of medical care but a natural and normal process. Palliative care, however, also requires a personal acceptance of death and an acknowledgment that dying does not denote a failure to provide good medical care but, rather, calls for an acquiescence that curative treatment is no longer feasible. Accordingly, the terminal state is an integral process and a time to reconcile differences so that patient and family may accept death with a minimum of physical, spiritual, and psychosocial anguish. This article discusses the various precepts cardinal to hospice and palliative care, including the philosophy of terminal care, the management of pain, the adverse effects of analgesic medications, the management of nonpain symptoms, the use of terminal sedation, and the stages of familial bereavement.