Common Palliative Care Procedures

Palliative care supports people living with serious or life-threatening illness and may be provided alongside treatments intended to manage or slow the underlying disease. Care may include symptom assessment, medication, comfort-focused procedures, emotional and spiritual support, communication, and planning for future care. The procedures used depend on a person’s condition, symptoms, preferences, goals, and available services.

Assessment and care planning

Palliative care consultation: An evaluation by a palliative care specialist or team to identify sources of distress, clarify goals, and recommend an individualized plan of care.
Symptom assessment: A structured evaluation of symptoms such as pain, breathlessness, nausea, constipation, fatigue, anxiety, confusion, or difficulty sleeping.
Pain assessment: Evaluating the location, type, severity, timing, triggers, and effect of pain on daily activities and quality of life.
Functional assessment: Evaluating how illness affects mobility, communication, eating, personal care, and other daily activities.
Medication review: Reviewing all prescription medications, over-the-counter medicines, supplements, and treatments to identify benefits, side effects, interactions, and opportunities to simplify care.
Goals-of-care conversation: A discussion about what matters most to a person, what outcomes they hope for, and which treatments fit their values and priorities.
Shared decision-making: A process in which the person, family or caregivers, and healthcare professionals discuss options, benefits, risks, and preferences before making a care decision.
Advance care planning: Discussing and documenting future healthcare preferences in case a person later cannot speak or make decisions for themself.
Advance directive: A legal document that records a person’s healthcare wishes and may name someone to make decisions if the person cannot make themself understood.
Healthcare proxy: A person legally designated to make healthcare decisions for someone who is unable to make those decisions.
Code status: Documentation of which emergency treatments, such as cardiopulmonary resuscitation, should or should not be provided if a person’s breathing or heartbeat stops.
Do not resuscitate (DNR) order: A medical order not to perform cardiopulmonary resuscitation if a person’s heart stops or they stop breathing.
Do not intubate (DNI) order: A medical order not to place a breathing tube into the trachea if a person cannot breathe adequately.

Symptom management and comfort measures

Comfort-focused care: Care intended primarily to relieve suffering, support dignity, and improve quality of life rather than focus only on treating the underlying illness.
Nonmedication symptom management: Using approaches such as repositioning, massage, relaxation, music, guided breathing, heat or cold, environmental changes, or emotional support to reduce distress.
Positioning: Adjusting a person’s body position to improve comfort, breathing, drainage, mobility, or pressure distribution.
Pain management: Using medication, procedures, rehabilitation, psychological support, and other approaches to reduce pain and improve comfort or function.
Breathlessness management: Assessing and treating the sensation of difficult or uncomfortable breathing with positioning, airflow, oxygen when indicated, medication, and emotional support.
Nausea and vomiting management: Identifying possible causes and using medication, hydration when appropriate, dietary changes, or other measures to reduce nausea and vomiting.
Constipation management: Preventing or treating difficult or infrequent bowel movements with fluids when appropriate, activity, dietary measures, stool softeners, laxatives, suppositories, or enemas.
Delirium management: Assessing sudden changes in attention, awareness, thinking, or behavior and addressing possible causes while supporting safety and comfort.
Fatigue management: Evaluating reduced energy and helping a person balance activity, rest, sleep, nutrition, and personal priorities.
Mouth care: Cleaning and moisturizing the mouth, lips, tongue, and gums to reduce dryness, discomfort, sores, and problems with oral secretions.
Skin care: Cleaning, moisturizing, protecting, and regularly assessing the skin to reduce discomfort, irritation, and pressure-related injury.

Medicines and medication delivery

Analgesic: A medication used to relieve pain.
Opioid therapy: Treatment with an opioid medication to relieve moderate to severe pain or, in some situations, breathlessness. The care team monitors benefits, side effects, and safety.
Breakthrough medication: An additional dose of medication used for a temporary increase in symptoms despite scheduled treatment.
Adjuvant medication: A medication used alongside a primary treatment to address a specific type of pain or another symptom.
Antiemetic: A medication used to prevent or reduce nausea and vomiting.
Laxative: A medication used to prevent or treat constipation.
Anxiolytic: A medication used to reduce anxiety when medication is clinically appropriate.
Corticosteroid therapy: Treatment with a corticosteroid medication to reduce inflammation or help relieve selected symptoms, depending on the person’s condition.
Medication deprescribing: Carefully reducing or stopping medications that no longer provide meaningful benefit or may add burden, in line with the person’s goals and clinical plan.
Subcutaneous injection: Injecting medication into the tissue beneath the skin when swallowing is difficult or another route is preferred.
Continuous subcutaneous infusion: Delivering medication continuously through a small needle or catheter placed under the skin, often using a portable infusion device.
Syringe pump: A small pump that delivers medication or fluids at a controlled rate, often through a subcutaneous line.
Intravenous (IV) medication: Giving medication through a vein when rapid effect, reliable absorption, or another clinical reason makes IV treatment appropriate.
Topical medication: Applying medication to the skin or a mucous membrane to treat a localized symptom or condition.

Breathing and secretion management

Oxygen therapy: Providing supplemental oxygen through a nasal cannula, face mask, or another device when it is likely to improve comfort or correct low oxygen levels.
Nasal cannula: Delivering oxygen through small, soft prongs placed at the entrance of the nose.
Nebulizer treatment: Turning liquid medication into a mist that can be inhaled into the lungs.
Airway suctioning: Removing saliva, mucus, blood, or other secretions from the mouth or airway when the person cannot clear them independently.
Secretion management: Using positioning, mouth care, medication, suctioning, or other measures to reduce distress from excess respiratory secretions.
Noninvasive ventilation: Providing breathing support through a mask or nasal interface without placing a breathing tube in the trachea. Whether it is used depends on the person’s goals and clinical situation.
Intubation: Placing a breathing tube into the trachea to support the airway and breathing. In palliative care, decisions about intubation are guided by the person’s goals and treatment preferences.
Palliative sedation: Carefully monitored use of medication to reduce awareness when a person has severe suffering that cannot be adequately relieved in another way. It is distinct from intentionally causing death.

Wound, pressure injury, and personal care procedures

Wound assessment: Examining a wound for its location, size, depth, drainage, odor, pain, infection, and effect on comfort or function.
Wound irrigation: Rinsing a wound with a suitable fluid to remove drainage, debris, or contaminants.
Wound dressing: Applying a protective covering to absorb drainage, control odor, reduce pain, protect the skin, and support healing when healing is expected.
Pressure injury prevention: Using repositioning, support surfaces, cushions, skin protection, nutrition support, and regular assessment to reduce pressure-related skin damage.
Pressure injury care: Cleaning, protecting, dressing, and managing pain or drainage from an area of pressure-related skin or tissue damage.
Ostomy care: Cleaning and protecting the skin around an opening that connects an internal organ to the outside of the body and managing the attached pouch or appliance.
Personal care support: Assisting with bathing, dressing, toileting, grooming, repositioning, and other activities in a way that protects dignity and comfort.

Tubes, drainage, and fluid management

Urinary catheterization: Inserting a flexible tube into the bladder to drain urine, relieve discomfort from urinary retention, or support personal care when appropriate.
Catheter care: Cleaning, securing, monitoring, and managing a urinary or other catheter to support comfort and reduce complications.
Paracentesis: Using a needle or catheter to remove fluid from the abdomen to relieve pressure, pain, nausea, or breathlessness, or to obtain fluid for testing.
Thoracentesis: Using a needle or catheter to remove fluid or air from the space around a lung to relieve breathlessness or chest discomfort.
Indwelling pleural catheter: A small tube left in the space around a lung so recurrent fluid can be drained over time, sometimes outside the hospital.
Drain management: Monitoring and caring for a tube that removes fluid, blood, pus, or other material from a body space or surgical area.
Venting gastrostomy: Using a tube placed into the stomach to release air or fluid and relieve symptoms caused by certain blockages or severe nausea and vomiting.
Bowel decompression: Removing gas or fluid from the digestive tract with a tube or another procedure to relieve pressure, nausea, vomiting, or discomfort.
Hydration review: Discussing whether fluids given by mouth, IV, or another route are likely to support comfort and align with the person’s goals.
Artificial nutrition review: Discussing the potential benefits, burdens, and goals of tube feeding or nutrition given through a vein.

Diagnostic and therapeutic procedures

Limited diagnostic testing: Selecting tests that are likely to change treatment, relieve symptoms, clarify prognosis, or support the person’s goals while avoiding unnecessary burden.
Laboratory testing: Testing blood, urine, or another sample to investigate a symptom, monitor a treatment, or identify a potentially reversible cause of distress.
Imaging: Using tests such as an X-ray, ultrasound, CT scan, or MRI when the result may guide a comfort-focused or goal-concordant treatment plan.
Nerve block: Injecting medication near a nerve or group of nerves to reduce pain in a specific area.
Epidural or intrathecal medication: Delivering medication near the spinal cord or into the fluid around the spinal cord to treat selected types of severe pain or other symptoms.
Palliative radiation therapy: Using radiation to reduce symptoms caused by a tumor, such as pain, bleeding, pressure, or blockage, rather than primarily to eliminate the disease.
Palliative surgery: Performing surgery to relieve a symptom or complication, such as an obstruction, bleeding, or pressure, when the expected benefit fits the person’s goals.
Stent placement: Placing a small tube or framework in a narrowed passageway to help keep it open and relieve a blockage when clinically appropriate.
Blood transfusion: Giving red blood cells or another blood component when it is expected to improve symptoms or quality of life and aligns with the person’s care goals.

Family support and care transitions

Family meeting: A structured conversation involving the person when possible, family or caregivers, and healthcare professionals to share information and discuss care decisions.
Caregiver assessment: Identifying the practical, emotional, social, cultural, and financial needs of people who support the person receiving care.
Social work consultation: Support with coping, communication, family concerns, practical needs, care coordination, and community resources.
Spiritual care consultation: Support for spiritual, religious, existential, or meaning-related concerns according to the person’s preferences.
Hospice referral: Connecting a person and their family or caregivers with hospice services when care is focused primarily on comfort and the person meets applicable eligibility requirements.
Home care planning: Coordinating medications, equipment, services, caregiver education, and clinical contacts needed for care at home.
Discharge planning: Preparing for a transition from a hospital, clinic, or facility with instructions, medications, equipment, follow-up, and contact information.
Transfer: Moving a person to another unit, facility, hospice program, or care setting for services that better match their medical needs and goals.
Follow-up: Additional evaluation, symptom review, caregiver support, or care coordination after a palliative care visit or procedure.

Palliative care procedures are individualized and should reflect the person’s values, goals, symptoms, cultural preferences, and desired level of medical intervention. Palliative care can be provided with disease-directed treatment and is not limited to the final days of life. The care team should explain the purpose, expected benefits, possible burdens, alternatives, and aftercare for a procedure whenever the situation allows.