Archives of General Internal Medicine

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Mini Review - Archives of General Internal Medicine (2025) Volume 9, Issue 1

End-of-Life Care in Internal Medicine: A Comprehensive Approach to Palliative Care and Advanced Directives

Baleiy Mathew*

Endocrine Surgery Unit, University of Sydney, Australia

*Corresponding Author:
Baleiy Mathew
Endocrine Surgery Unit, University of Sydney, Australia
E-mail: mathewb@uni.sydney.edu.au

Received: 02-Jan-2025, Manuscript No. AAAGIM-25-162834; Editor assigned: 03-Jan-2025, PreQC No. AAAGIM-25-162834 (PQ) Reviewed:17-Jan-2025, QC No. AAAGIM-25-162834Revised:24-Jan-2025, Manuscript No. AAAGIM-25-162834 (R); Published:28-Jan-2025, DOI: 10.35841/aaagim.9.1.280

Citation: Mathew B. End-of-Life Care in Internal Medicine: A Comprehensive Approach to Palliative Care and Advanced Directives. Arch Gen Intern Med. 2025;9(1):280

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Abstract

  

Introduction

End-of-life care is a critical aspect of internal medicine, involving the management of patients with advanced, life-limiting illnesses. As the population ages and chronic diseases become more prevalent, healthcare providers are increasingly tasked with offering compassionate care that emphasizes comfort, dignity, and patient-centered decision-making. This mini-review explores the importance of palliative care in end-of-life management, the role of advanced directives, and the comprehensive approach required in internal medicine to address these sensitive and complex issues..

Palliative Care in End-of-Life Management

Palliative care is an approach that aims to improve the quality of life for patients with serious, life-limiting conditions by managing symptoms, alleviating suffering, and addressing the psychological, social, and spiritual aspects of care. Unlike curative treatments, which focus on eradicating disease, palliative care is centered on the relief of pain and other distressing symptoms such as nausea, shortness of breath, fatigue, and anxiety. It is applicable to patients of any age and at any stage of a serious illness, not just at the end of life.

Symptom Management:

Effective symptom control is the cornerstone of palliative care in end-of-life scenarios. Internal medicine physicians often work collaboratively with palliative care teams to manage both physical and psychological symptoms. Common interventions include opioid medications for pain relief, antiemetics for nausea, anxiolytics for anxiety, and corticosteroids for improving appetite and reducing inflammation. A comprehensive approach ensures that the patient’s physical needs are met while addressing emotional distress through counseling and support.

Multidisciplinary Team Approach:

A hallmark of palliative care is its multidisciplinary nature. The palliative care team typically includes physicians, nurses, social workers, chaplains, and psychologists, all working together to address the full range of patient needs. In internal medicine, the primary physician plays a central role in coordinating care, integrating the input of specialists, and ensuring that the patient’s wishes are respected.

Patient-Centered Communication:

Open, honest, and compassionate communication is a key component of palliative care. Internal medicine physicians must engage in discussions about prognosis, treatment options, and goals of care early in the course of illness. Conversations about end-of-life care should focus on the patient’s preferences and values, ensuring that treatment aligns with the patient's wishes. This is particularly important in patients with advanced, non-curable diseases such as metastatic cancer, end-stage heart failure, or neurodegenerative diseases. [2].

 

Advanced Directives: A Vital Tool for End-of-Life Planning

Advanced directives are legal documents that allow patients to express their wishes regarding medical treatment in the event they are unable to communicate due to illness or incapacity. These directives play a crucial role in ensuring that a patient's values and preferences are respected, especially when they are near the end of life. There are two main types of advanced directives—living wills and durable powers of attorney for healthcare. A living will outlines the patient’s preferences for medical interventions, such as resuscitation, mechanical ventilation, or feeding tubes, in the event of a terminal illness or irreversible condition. A durable power of attorney for healthcare designates a trusted individual to make medical decisions on behalf of the patient when they are incapacitated.

Internal medicine physicians are often responsible for discussing advanced directives with patients and ensuring that their wishes are clearly documented. These conversations should be approached with sensitivity, recognizing that patients may have different cultural, religious, or personal beliefs about life-sustaining treatments. Physicians should ensure that patients understand the potential consequences of their choices and update their directives as their health status changes.

Physicians must navigate complex ethical issues when discussing advanced directives and end-of-life care. In cases where patients have not provided clear directives or have conflicting family opinions, internal medicine physicians must engage in ethical decision-making, ensuring that the patient’s autonomy is respected while balancing the family’s emotional concerns and the physician’s medical expertise. [3].

Comprehensive Approach to End-of-Life Care in Internal Medicine

End-of-life care requires a holistic approach that goes beyond just medical treatment. It is important for physicians to address the psychological and emotional well-being of patients and their families. This includes providing grief counseling, facilitating family meetings to discuss care plans, and ensuring that patients and their families feel supported throughout the process.

Different cultures and religions have varying beliefs and practices surrounding death and dying. Internal medicine providers must be culturally sensitive and aware of these differences when providing end-of-life care. For example, some patients may prefer to die at home surrounded by family, while others may want to be in a hospital setting. Understanding and respecting these preferences is crucial to providing compassionate care. [5].

For patients in the final stages of life, hospice care becomes an essential aspect of palliative care. Hospice is a form of care that focuses on comfort and quality of life, providing symptom management, emotional support, and spiritual care for patients with a prognosis of six months or less to live. Internal medicine physicians may refer patients to hospice services when curative treatment is no longer an option, ensuring that the patient receives comprehensive support in their final days.

End-of-life care is not only about managing the patient's symptoms but also providing support for the family. Internal medicine physicians should provide guidance to families on what to expect in the final stages of life and help them navigate the emotional complexities of saying goodbye. This support often extends beyond the patient’s death, offering bereavement services to help families cope with their loss. [6-10].

Conclusion

End-of-life care in internal medicine is an essential, multifaceted aspect of patient care, involving careful management of symptoms, compassionate communication, and respect for patient wishes. The integration of palliative care and advanced directives into clinical practice ensures that patients with life-limiting illnesses receive the highest quality of care in their final stages. Internal medicine physicians play a pivotal role in facilitating these conversations, coordinating care, and ensuring that patients’ values are respected. By adopting a comprehensive and patient-centered approach to end-of-life care, healthcare providers can help patients navigate this difficult time with dignity and comfort.

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