If you’ve never heard of palliative care, you’re not alone. In a recent survey, only 24 percent of people said they were familiar with the term. Palliative care isn’t nearly as well known as, say, hospice care; in fact, people often confuse the two. its use is growing fast, however, and 59 percent of hospitals with more than 50 beds now have palliative care programs. Hospitals like this type of care because it appears to be cost-effective and may improve health outcomes. Patients — once they know about it — like it because it can make them feel better.

The goal of palliative care is simple: Improve the quality of life for people who are dealing with serious chronic or life-threatening medical problems. People with diseases such as cancer, congestive heart failure, HIV/AIDS and kidney failure often have tremendous problems with pain, shortness of breath, fatigue and nausea, among other symptoms. especially in a busy hospital, it’s challenging to keep these patients comfortable and pain-free and to help them deal with the difficult medical and personal decisions they may face. That’s where palliative care comes in.

Specially trained palliative care teams, which typically include a doctor, a nurse, a social worker and a spiritual counselor, focus on relieving pain and managing symptoms. They coordinate a patient’s care among different providers, if necessary, and help patients and their families determine care goals and make treatment decisions. If a patient is nearing death, the palliative care team can offer emotional and spiritual support.

‘more comfort’

Palliative care — from the Latin “palliare,” which means “to cloak” — grew out of the hospice movement that began in the 1970s. “We showed that you don’t have to die in pain,” recalls Michael Levy, director of the pain and palliative care program at Fox Chase Cancer Center in Philadelphia. “you can have more comfort and function, and attend to the anticipatory grief work that helps the patient and the family.”

As hospice care became more established, policymakers and clinicians realized that seriously ill patients, even when not facing death, could benefit from better pain and symptom management and other palliative care services. Today, hospice care is at one end of the spectrum of palliative care. but while hospice is generally offered to people who are expected to live six months or less, palliative care can be provided in conjunction with curative treatments. many patients who receive it aren’t expected to die anytime soon.

After Andre Chervin began a series of radiation sessions in 2008 to treat a cancerous mass in his throat, he caught a virus that causes severe diarrhea and was admitted to Mount Sinai Medical Center in New York for a week. while there, Chervin was in extreme discomfort because the radiation treatments had dried up his saliva, making his mouth and throat so dry that he couldn’t swallow.

“It was horrible,” says Chervin, now 83. “you cannot eat; you can only drink.”

The palliative care team visited him and set him up with a spray bottle that contained artificial saliva that he could spray into his throat. the liquid didn’t taste pleasant, but at least it allowed him to swallow.

Patients are sometimes confused and alarmed when the palliative care team comes to their room, says Donna Nolde, palliative care program manager for Chandler Regional Medical Center and Mercy Gilbert Medical Center, both near Phoenix.

When members of the team introduce themselves, they immediately clarify that they’re not hospice workers. “you have to do it quickly or you lose them,” she says. “They think, ‘There’s something wrong with me!’ “

Although palliative care is still a relatively new field, research is beginning to show benefits. A study published last year in the New England Journal of Medicine found that lung cancer patients who received palliative care had better quality of life, were less depressed and lived longer than those receiving standard care.

Palliative care is cost-effective as well. A study in the March edition of Health Affairs found that Medicaid patients at four New York state hospitals who received palliative care on average incurred nearly $7,000 less in hospital costs per admission than Medicaid patients who didn’t receive palliative care. this study supports the results of a 2008 Archives of Internal Medicine study of non-Medicaid patients at eight hospitals that showed average savings of about $1,700 for those who survived a hospital stay and $4,900 for those who did not.

Despite its apparent cost-effectiveness, insurers typically don’t yet reimburse hospitals for palliative services beyond doctor visits and care related to hospice.

“Unless you have a health-care system or a large hospital funding the rest of the team, you really can’t provide (palliative) care,” says Michael Nisco, medical director of hospice and palliative care services at Saint Agnes Medical Center in Fresno, Calif.

When Martin Arnold’s 94-year-old mother was admitted to Saint Agnes last month, a blood clot in her leg had caused a systemic infection; her condition was dire.

When she arrived at the hospital, Arnold says, she was in tremendous pain, moaning and fidgeting. A member of the palliative care team visited her and gave her a morphine drip to ease the pain in her leg. She went to sleep and never regained consciousness.

“It was a total relief to the family to get her someplace where they were able to give her what she needed to keep her peaceful,” he says.

Most people with serious illnesses aren’t in the hospital, of course, and the future of palliative care lies outside acute-care facilities, says Diane E. Meier, Mount Sinai’s palliative care program director and the director of the Center to Advance Palliative Care, a group that helps hospitals and others develop palliative care programs. In the next decade, she expects to see palliative care emerge in individual physician offices, clinics and other community settings.

“That’s where most of the patients are,” she says, “and that’s where the need is.”

This column is produced through a collaboration between the Washington Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente.

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6 January 2011 last updated at 04:25 ET Share this page there are more than 200 cases of H1N1 infection in Northern Ireland

The doctor in charge of acute hospital services in Belfast has said there are fewer critical cases of swine flu this year, but those affected are more ill.

Dr Patricia Donnelly said although critical care units were busy, beds were still available in Belfast and across Northern Ireland.

She said in Belfast there were five patients with swine flu in critical care out of a total of 33.

Across NI the number was fluctuating between 25% and 35% of critical beds.

She said there was only one child with swine flu in critical care and another child with a different type of flu.

"a smaller number of patients are affected this time, but those who were affected definitely are sicker," Dr Donnelly said.

"Critical care is always busy throughout the year, but we have well tested plans to increase our capacity as and when it is required.

"At this point in time both in Belfast and across the region we are using those escalation plans and we have created additional capacity."

Significant rise

Meanwhile, the deputy chair of the BMA's NI GPs committee has said he expects to see a "significant rise" in the number of cases of swine flu in Northern Ireland when figures are released on Thursday.

The Public Health Agency (PHA) will publish new figures later.

Dr Tom Black said GPs had dealt with an increase in flu like illness over Christmas and new Year and he expects the PHA figures to reflect this.

More than 200 people are currently being treated for the virus.

Dr Black said the "predominant strain to date is the H1N1 swine flu".

He said GPs are advising patients in the high risk groups,who have not yet attended for flu vaccination, to contact their practice.

"Normally healthy patients with flu like symptoms can usually stay at home taking fluids and paracetamol, only contacting their GP if they developed complications such as chest pain, shortness of breath or confusion," he said.

Pregnant women

"it is very important that all pregnant women attend for vaccination as swine flu is four times more risky for them."

The PHA is also urging all pregnant women to get the swine flu vaccine.

The number of people found to have the H1N1 swine flu virus in NI in the week before Christmas had previously doubled to 129.

On Tuesday the Public Health Agency revealed the number of swine flu cases in Northern Ireland has increased to more than 200, in the last week.