Many people think hospice and palliative care come at the end of life, and while both often play a key role then, palliative care also can provide pain relief, symptom control, emotional comfort and spiritual support as patients recover from serious illnesses. National Hospice Palliative Care Month is held in November to educate physicians and patients and their families about hospice care, palliative care and their similarities and differences. Donna Kamann, a palliative care nurse practitioner at Mayo Clinic Health System in La Crosse, explains these growing and evolving medical specialties and how they can help patients and their loved ones.

At Mayo, for example, palliative care teams include physicians, advanced-practice nurses, chaplains, licensed clinical social workers, pharmacists and physical and occupational therapists. Starting with their individual expertise, the members build a care plan that carefully considers each patient's unique needs. Palliative care can segue into hospice care if the illness becomes terminal.

"Respecting the desires of patients -- as well as their families and their caregivers -- palliative care seeks to improve quality of life in the face of serious illness," Kamann says. "Palliative care treats people suffering from serious and chronic illnesses such as cancer, cardiac disease such as congestive heart failure, chronic obstructive pulmonary disease, kidney failure, Alzheimer's, Parkinson's, amyotrophic lateral sclerosis and many more."

Palliative care and hospice care can provide:

*Pain management: Most patients and families want every effort be made to relieve pain. It is important for the patient to receive the appropriate medication for his or her condition. Different types of pain require different medications.

*Symptom control: This includes management of the symptoms associated with the illness and side effects of treatment: pain, nausea/vomiting, poor appetite, shortness of breath, loss of energy, sleep disturbances, anxiety and depression related to the illness, and delirium, Kamann says.

*Emotional support: It is natural to feel sad, angry, panicked, or helpless when you or someone you love becomes ill. Team members help patients and families develop coping skills and ease anxiety over how illnesses may progress. They also can assist with difficult conversations that patients and families may want to have, but do not know how to start. The simple presence of someone who loves the patient can be extremely soothing and helpful.

*Spiritual care: Spirituality and spiritual life are about religion and anything else through which a person finds meaning, says Michael Brown, a chaplain in spiritual care at Mayo Clinic Health System. "Spirituality is a practice that cultivates the deepest aspects of who we are," Brown says. He suggests providing an atmosphere that is in harmony with the patient's wishes. Music therapy, massage therapy, reiki and healing touch are among options available to patients in palliative care.

Palliative care is available at any time during a serious or life-threatening illness, while hospice care is available only during the final months of life -- when curative or life-prolonging treatments have been stopped. Hospice care can be provided at home or on an in-patient basis. Roughly 1.6 million people with life-limiting illness receive care from U.S. hospice or palliative care providers, according to the National Hospice and Palliative Care Organization.