A decision to begin palliative care takes in many factors. Ideally the decision includes a discussion with the health care team, who can offer information about options and available support. Several questions can help determine when palliative care becomes the main focus of care:

• What options are available for treatment?
• What does the person living with the illness want?
• What options are available for palliative care or symptom control?
• What is the nature and the course of the illness?

What options are available for treatment?

If someone has received all the treatments that might change the course of the underlying illness, then the next step is to focus on comfort. In this situation, the timing of palliative care is mostly determined by the illness and its treatment.

What does the person living with the illness want?

Some people choose a comfort-focused approach right from the time of diagnosis of a progressive illness. For instance, someone may have several treatment options, such as surgery and chemotherapy, but after reviewing them carefully with the health care team decides against them. In these situations, the timing of palliative care is mostly determined by the patient’s wishes.

What options are available for palliative care or symptom control?

Hospice or palliative care programs have criteria for their services. Typically someone who has less than six months left to live can be eligible. Someone with a prognosis of a few years can still choose a comfort-focused approach. This person isn’t usually eligible for a formal program, but can still get advice on pain and symptom control through consultation services. In this situation, the timing of hospice care is mostly determined by the availability of palliative care services.

Resources: Programs and Services

What is the nature and course of the illness?

The path of a progressive illness, such as an incurable cancer, can often be anticipated. It’s usually clear when it’s time to focus mainly on comfort. At this point a person's condition appears to be declining steadily and the ability to function independently becomes a challenge. With a chronic condition, or when someone has several medical problems but no specific terminal diagnosis, it’s harder to recognize terminal stages. Setbacks or complications can happen throughout the illness and may be treatable and reversible. In early stages, palliative measures such as pain control may be only a small part of overall care. As the illness progresses, some previously reversible problems become irreversible, or the burden of treatment outweighs its benefits. Then the focus of care turns increasingly toward comfort. For example, someone with lung disease may have had pneumonia previously, and had treatment in hospital to overcome the infection itself. With a palliative approach, symptoms such as shortness of breath are treated, while treatment for the pneumonia itself may or may not be given. The change of focus can come from the patient, or it can be determined by the illness. In such situations, it’s best to integrate palliative care into overall health care, rather than to choose a specific starting point.

Increasingly, palliative care advocates promote a combined approach to care for patients with life-threatening illnesses. This means that palliative care provides comfort even while a disease is being treated. Advocates believe this approach helps people make more informed decisions about their care. The World Health Organization (WHO) defines palliative care as "applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life."

A person doesn’t have to be involved in a formal program to receive palliative care. In some areas, people can get palliative care from their health care team, and become part of a formal palliative care program near the end of life. The criteria for palliative care services can vary. The point is that just because someone isn’t a patient in a designated palliative care unit or part of a palliative care program doesn’t mean that palliative care isn’t or can’t be provided.