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. 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. 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. 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. 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. 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

To find palliative care in your area, visit our Provider Directory