I Am Living

Sadly, there are misleading myths about palliative care that need to be debunked. Transparent, honest communication together with accurate, evidence-based information and timely planning will enable individuals, their caregivers and loved ones to focus on living as well as possible at their end of life.

Here are some false narratives about palliative care that have circulated recently, along with evidence-based facts dispelling them.

Myth 1: Pain is an inevitable part of the dying process.

Fact 1

Pain management is a key part of palliative and end-of-life care. Palliative care focusses on eliminating, or relieving physical and psychological pain. Importantly, pain management approaches are unique, person-centric and developed by teams of professionals such as doctors, nurses and allied health professionals, who respond to the specific needs of each person.

The truth is pain can be managed through a range of prescribed medicines and treatments. Laser therapy, massage, acupuncture, meditation, as well as other therapies, practices, and innovative techniques can help people live with pain.

Myth 2: Palliative care means GPs or specialists have given up and there is no hope.

Fact 2

Doctors refer persons to palliative care specialists and services in order to access the very best supports to enable them to live the best life possible until their death.

While some diseases are incurable, people may live with these Illnesses for several years or decades.

For some people with a serious life-limiting illness, palliative care may be beneficial from the time of diagnosis. Palliative care can be given alongside other treatments. (for example chemotherapy) or interventions (for example surgery, organ transplant).

Myth 3: Palliative care is only available in the last few days of dying.

Fact 3

Palliative care can be accessed once a person is diagnosed with an advanced illness that is expected to ultimately cause their death. Individual care needs vary and some people access palliative services for a long time (for example years, decades).

Palliative care assists in managing symptoms such as pain, fatigue, shortness of breath, nausea, and vomiting. Psychological, social, cultural, and spiritual needs are also addressed to ensure that people live, die, and grieve well.

Myth 4: Palliative care speeds up the dying process, it’s the beginning of the end.

Fact 4

Studies have demonstrated that people with advanced illness who receive palliative care have improved quality of life and have been shown to live longer, with a better quality of life, than people with the same illness without palliative care.

Myth 5: People receiving palliative care who stop eating die of starvation.

Fact 5

The last stages of advanced illnesses commonly lead to diminished appetite and thirst because of the body’s decreased need for nourishment. Unless the person desires food, it isn’t essential, but keeping the mouth moist and comfortable is very important to overall wellbeing.

Myth 6: Palliative care is only provided in a hospital.

Fact 6

Persons and families can receive palliative care in a variety of settings, including hospitals, hospices, aged care homes, and in their home.

Myth 7: Palliative care is just for people with cancer.

Fact 7

Palliative care is available to anyone living with a life-limiting illness including, but not limited to, organ failure, dementia and other neurological illnesses, elderly frailty, and certain conditions among children.

Myth 8 : We expect to die like in the movies, taking our last breath surrounded by family and friends.

Fact 8

Death and dying is more unique and complex than depicted in films. Factors such as illness, support, mobility, age, and gender can all influence the dying process. Generally, a ‘good’ death is one where the person’s physical, psychological, social, spiritual, and cultural needs have been addressed, so they’re as comfortable and as calm as possible. Addressing a person’s health and end of life goals should be at the centre of all discussions and approaches, so their needs are consistently honoured and met.

Myth 9: Once on morphine, the end is near.

Fact 9

People may use morphine for many months to control pain and breathlessness. Morphine does not cause death; it is the underlying illness that ultimately results in death.

Myth 10: Allergies to opioids include side effects such as nausea, vomiting and constipation.

Fact 10

Your doctors, nurses and other health care workers will take a history of your experience with these medications and consider alternative medications or dose changes to avoid adverse reactions (for example vomiting, nausea). ‘Adverse reactions’ to medications are commonly referred to as ‘side effects’.

People receiving palliative medication, together with their carers, can observe their symptoms carefully and discuss their experience with their health care team. This approach is very helpful in preventing many side effects.

Allergies to morphine or opioids are rare.

Myth 11: Morphine is addictive.

Fact 11

As long as it is used to relieve pain, morphine or any other opioid is not addictive.

Myth 12: Tolerance to morphine will develop and higher doses will be needed.

Fact 12

As the disease progresses, pain and breathlessness may increase, increasing the need for pain relief. Morphine and other opioids do not develop tolerance when used to manage symptoms like pain and breathlessness.

Myth 13: Injections of morphine and other opioids are more effective than oral dispensation.

Fact 13

In general, the method of administration of morphine and other opioids does not affect the effectiveness of the medication. However, types of long-acting, slow-release medication require less frequent administration and can offer better pain control.

Myth 14: Codeine is a better drug than morphine.

Fact 14

Codeine is a morphine derivative with less analgesic and sedative effects than morphine.  In the body, codeine is converted to morphine. Codeine is often used for minor pain in the community, however, not commonly used in the palliative care setting.

Myth 15: Euthanasia and assisted suicide are part of palliative care.

Fact 15

Palliative care focuses on quality of life and symptom control to better manage a life limiting illness.

Euthanasia and assisted suicide are not part of palliative care. Euthanasia and assisted dying is a different and separate intervention and assessment process that involves the person choosing to end their life in the context of a life-limiting illness.