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, or someone close to you, have a serious illness such as:
- Cancer
- Congestive heart failure
- Chronic obstructive pulmonary disease (COPD)/emphysema
- Kidney failure
- Liver failure
- Dementia
Yes

No
2. Do you, or someone close to you, have symptoms such as:
- Pain
- Shortness of breath
- Fatigue
- Anxiety
- Depression
- Lack of appetite
- Nausea
- Constipation
Yes

No
3. Have you, or someone close to you, experienced the following:
- Frequent emergency room visits
- Multiple admissions to the hospital (3 or more within 12 months) with the same symptoms
- A turning point in the illness where treatment is no longer working
- Eating problems associated with an advanced illness
Yes

No
4. Do you, or someone close to you, need help with:
- Future planning
- Decision making
- Emotional support
- Spiritual or religious support
Yes

No

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Is Palliative Care Right for You?