Is Palliative Care Right for You?
Answer the following questions to determine whether palliative care might be right for you or someone close to you. Remember, you can receive palliative care at any point in your illness.
1. Do you have one or more serious illnesses such as:
Cancer
Congestive heart failure (CHF)
Chronic obstructive pulmonary disease (COPD), emphysema, lung disease
Kidney failure
Liver failure
Neurological diseases (e.g., ALS, Parkinson's)
Dementia
Yes
No
2. Do you have symptoms that make it difficult to be as active as you would like to be, or impact your quality of life? These symptoms might include:
Pain or discomfort
Shortness of breath
Fatigue
Anxiety
Depression
Lack of appetite
Nausea
Constipation
Yes
No
3. Have you, or someone close to you, experienced the following:
Difficult side effects from treatment
Eating problems due to a serious illness
Frequent emergency room visits
Three or more admissions to the hospital within 12 months, and with the same symptoms
Yes
No
4. Do you, or someone close to you, need help with:
Knowing what to expect
Knowing what programs and resources are available
Making medical decisions about treatment choices/options
Matching your goals and values to your medical care
Understanding the pros and cons (benefits/burdens) of treatments (e.g., dialysis, additional cancer treatments, surgery, etc.)
Yes
No
5. Do you, or someone close to you, need help with:
Coping with the stress of a serious illness
Emotional support
Spiritual or religious support
Talking with your family about your illness and what is important to you
Yes
No
Submit
Should be Empty: