Mar 10, 2026
At a time when modern medicine is allowing people to enjoy
longer, fuller lives, mortality is not always a chief concern. But
when a serious illness occurs, the topic becomes unavoidable. This became especially clear during the early days of the
COVID-19 pandemic when hospitals were overrun with patients, many
with grim prognoses. “The pandemic gave all of us a sense that life
can be short and there’s the very real possibility of dying,”
says Jennifer Kapo, MD, director of the
Palliative Care Program at Yale New Haven Hospital. “It opened the
door for us to talk more about death and have a better sense of our
mortality.” Palliative care is a caregiving
approach for anyone with a serious or chronic medical condition;
its goal is to maximize quality of life and manage symptoms. In
addition to helping patients and their families navigate difficult
conversations and decisions, palliative care team members are
attentive to “goals of care,” which means understanding the
patient’s wishes and how medical steps can help achieve them. For example, if a patient has a low likelihood of coming off a
ventilator, that would be made clear to them, if possible, before
they were put on one, explains Laura Morrison, MD, a physician in
the Palliative Care Program. “The pandemic highlighted the need for us to have more proactive
and earlier conversations with patients and their families. If we
gave them the chance to make a choice, some might say they don’t
want to die in an intensive care unit,” Dr. Kapo adds. Still, many people still aren’t sure what palliative care really
means. Below, we talk with a few members of Yale Medicine’s program
to better understand it. Palliative care is a specialized model of care for people living
with serious or chronic illnesses including cancer, heart and liver failure, dementia, and pulmonary disease. Like hospice care, the focus is on maximizing comfort and
quality of life. But palliative and hospice care differ in that
hospice is for patients who are not receiving life-extending
treatment, and is typically limited to the last six months—or
less—of one’s life. Palliative care, conversely, can be integrated
into a patient’s medical care at any point during their illness,
from diagnosis to end-of-life, and can include life-extending
medical treatment. “Essentially, palliative care is an extra layer of support for
any patient who has a serious illness. That can include attention
to pain and other symptom management, as well as help coping with
the stress of having the illness,” Dr. Morrison explains. “We also
focus on facilitating communication between patients, their
families, and medical providers.” The Palliative Care Program has 35 members in various
disciplines, including physicians, nurses, social workers, a
chaplain, a psychologist, and a pharmacist. Palliative care
services are offered to all patients at Yale New Haven Hospital and
Smilow Cancer Hospital, and at Smilow’s outpatient offices. And it
provides care on a spectrum, based on what patients and their loved
ones need in the moment. “At the beginning of a serious illness, a patient’s needs might
revolve around addressing anxiety over their diagnosis,” Dr. Kapo
says. Plus, taking care of the entire family, and not just the
patient, is an important element, Dr. Kapo adds. “Our goal is to
provide the best quality of life possible to patients and their
families, which is why our bereavement program is also an important
element. Our care does not stop when a loved one dies,” she
says. Because Yale Medicine offers palliative care to hospitalized
patients, that is often where someone first hears about the model
of care. “We typically structure the conversation broadly at first and
ask a patient what they understand about their illness, what they
have heard about it, and what they believe about it,” Dr. Kapo
says. “If a patient has no idea that death is a real possibility,
we spend a lot of time sharing information. Or, if they have been
sick for five years and know that time may be short, we talk about
what is important to them and what they want to do with the time
they have left.” That, Dr. Kapo says, opens a conversation about a patient’s
values. “We listen very carefully and get a sense of whether this
is a patient with goals of wanting to extend life no matter what it
takes, or someone who is more interested in quality of life,” she
says. The goal of palliative care is not to change a patient’s mind
about their decisions, she adds. “It’s to listen to a patient’s
story and support their decisions,” Dr. Kapo says. “If someone
tells me that they will fight for every last second of life, no
matter what the cost might be physically, then we honor that.” Meanwhile, a social worker can provide support and address any
psychosocial issues. For example, if someone is just diagnosed with
a critical illness, their primary concern might be how they can
still work and pay their bills. The team’s social worker can help
them navigate the logistics of their health insurance coverage and
sick time policies, among other issues. With other patients, the social worker might help explain a
diagnosis to a patient’s children in an age-appropriate way. The program also has a medical-legal partnership that assists
patients with estate planning; navigating entitlements, including
Social Security and insurance; and advance directives (a living will), a
written statement of a patient’s wishes regarding medical treatment
in the event they are unable to communicate them to a doctor. Palliative care is by no means a new medical concept. In fact,
it was all medical providers had before many current treatments
were invented. “Back in the early 20th century, before
antibiotics and chemotherapy and many other therapies we now have,
physicians provided palliative care as their treatment,” Dr.
Morrison says. “Our job was to be present, hold hands with
patients, and relieve symptoms as it was possible. Morphine might
have been given for pain.” Today, palliative care encompasses not only all the advanced
medical treatments and medications now available, but it is
increasingly being woven into care for chronic conditions. Meanwhile, research has shown that palliative care is effective.
One study published
in The New England Journal of Medicine in 2010
examined patients newly diagnosed with metastatic non-small cell
lung cancer. One group received standard oncologic care; the other
had standard oncologic care with palliative care added on. Those in the palliative care group reported less anxiety and
depression and were also hospitalized less. They also lived a month
longer. Subsequent similar studies expanding to other populations
with advanced serious illness have also shown positive
outcomes.
(CREDITS: YALE MEDICINE)How does palliative care
differ from hospice care?
How is palliative care
broached with patients?
What are the benefits of
palliative care?