Palliative Care in Obstetrics and Gynecology.
Palliative care is specialized care for people with life-limiting illness; it focuses on symptom management and quality of life and ensures that a patient's care is concordant with her goals and values. Unlike end-of-life care, palliative care can be offered concurrently with disease-directed therapies, including when the goal is cure. Obstetrics and gynecology patients for whom palliative care is most appropriate include women with gynecologic cancer and women with a fetus or neonate with a potentially life-limiting illness. Integration of palliative care for these patients offers both clinical and health care utilization benefits, including improved symptom management, improved quality of life, and high-value care. Palliative care can be provided by palliative care specialists (specialty palliative care) or by the team treating the life-limiting illness (primary palliative care), depending on the complexity of the need. Health care providers caring for patients with life-limiting illness, including obstetrician-gynecologists, must possess a basic primary palliative care skill set, including symptom management for common symptoms such as pain and nausea and communication skills such as breaking bad news. This skill set must be taught and evaluated during training and used consistently in practice to ensure that our patients receive truly comprehensive care.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, and the Department of Internal Medicine, Division of General Internal Medicine, Palliative Care Service, University of Colorado Denver School of Medicine, Aurora, Colorado; and the Departments of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, and Southern California Kaiser Permanente Medical Group, Panorama City, California.
Carolyn
C
Lefkowits
Caroline
C
Solomon
D032722:Advance Care Planning; D003142:Communication; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D008017:Life Expectancy; D019964:Mood Disorders / Q000209:etiology / Q000628:therapy; D009325:Nausea / Q000628:therapy; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010166:Palliative Care / Q000592:standards*; D010348:Patient Care Team; D018743:Perinatal Care; D066087:Perinatal Death; D058996:Quality Improvement; D011788:Quality of Life; D013727:Terminal Care; D014342:Truth Disclosure