Can you benefit from palliative care?

Answer the following questions to see if palliative care might be helpful to you or someone close to you. Remember that for many patients with serious illnesses, the sooner you engage with palliative care, the more it can help. Palliative care medicine is available to you at any time during your illness, and you can receive support from a palliative care medicine team while you are receiving other treatments for your illness.

1. Do you have one or more serious illnesses such as the following?

Cancer
Congestive heart failure (CHF)
Chronic obstructive pulmonary disease (COPD), emphysema or lung disease
Kidney failure
Liver failure
Neurological diseases such as ALS or Parkinson’s
Progressive Dementia
Alzheimer’s disease

1. Do you have one or more serious illnesses such as the following?

YesNo

2. Do you have active symptoms that are causing moderate to severe distress and impacting your quality of life? Symptoms might include:

Pain/discomfort
Shortness of breath
Fatigue
Anxiety and/or Depression
Appetite changes
Nausea
Constipation

YesNo

3. Have you had multiple hospitalizations within six months?

YesNo

4. Do you have healthcare wishes, such as advance care planning needs and/or goals of care you would like to have clarified and documented?

YesNo

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Learn about palliative care services in your area.

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