Decisions about palliative care must distinguish between a general palliative care approach and palliative care services, which often have limited resources.

A palliative approach to care is broadly aimed at ensuring comfort and quality of life for people with a life-threatening illness. Ideally, this approach is an integral part of supporting a patient and family throughout the entire course of the illness, even when there’s a possibility of a cure. Palliative care programs, on the other hand, have to focus their often limited resources, and so they target those in greatest need. Different regions and programs have their own eligibility requirements, but commonly people meet these criteria:

• a specific prognosis (often six months or less);
• a decision to focus on comfort rather than cure;
• an acceptance that resuscitation won’t be used when the illness brings a natural death.

Ideally, a person can get at least some elements of palliative care from the time of diagnosis. This can help with pain and other symptoms, or can help guide complex decisions. Palliative care may be central to treatment if the illness is aggressive and other treatment options are limited. Many palliative care programs offer early consultation to the oncologist or other specialists providing treatment.

In Canada, more comprehensive palliative care is generally offered to people who are expected to die within a certain amount of time, typically within six months. The goals of care then shift toward comfort. Eligibility criteria vary among programs or facilities.

Palliative care programs may not offer highly technical tests and treatments. The programs may require that patients and families not expect those tests and treatments or that treatments needing close monitoring, such as chemotherapy, are completed prior to acceptance to the program. Radiation treatments generally are less of a burden than chemotherapy and often are accepted by palliative programs. These criteria have more to do with the program’s resources than with the philosophy of palliative care.

Another common criterion in palliative care programs is an acceptance that resuscitation won’t be used. Cardiopulmonary resuscitation (CPR) is intended to restore heart function and breathing. When death is the natural outcome of the person’s underlying illness, that is, when the heart has stopped functioning as the result of the overwhelming burden of the illness on the body, then attempts to start the heart with CPR do not work. CPR generally is not offered by palliative care programs. If a patient expects CPR, then care likely will be provided in a setting other than a palliative care unit.

The referral process for palliative care varies also. Commonly it involves a referral form filled out by the patient’s physician or health care team. Sometimes the health care team waits for cues that the patient and family are ready for palliative care. Similarly, the patient and family may wait for cues from the team. This confusion and reluctance to talk about how things are going may cause unnecessary delay in providing palliative care.