Palliative Care Approach to Chronic Diseases: End Stages of Heart Failure, Chronic Obstructive Pulmonary Disease, Liver Failure, and Renal Failure.

Management of chronic diseases is often palliative by definition. Empowering primary care providers to manage symptoms and effectively prognosticate is necessary for this challenging population. In this article, the authors focus specifically on end-stage congestive heart failure, chronic obstructive pulmonary disease, end-stage kidney disease, and end-stage liver disease and how palliative principles can guide decision making and symptom management in these disease states. Special considerations in advance care planning, initiation and cessation of advanced therapies, and discussions on when to initiate hospice are included in this article.