Palliative care
Palliative care is specialized medical care that focuses on providing patients relief from pain and other symptoms of a serious illness, no matter the diagnosis or stage of the disease. Palliative care teams aim to improve the quality of life for both patients and their families. Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with a life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment, and treatment of pain and other problems, whether physical, psychosocial, or spiritual. Palliative medicine was introduced in the Ministry of Health (MOH) in 1995.
OBJECTIVES OF SERVICE
To provide comfort and relief of distressing physical symptoms related to advance and incurable, progressive life-threatening conditions.
To provide support to patients and family members facing psychosocial and spiritual issues related to incurable, progressive life-threatening conditions.
To prevent and minimize suffering by early identification, impeccable assessment, and prompt intervention of physical, psychosocial, and spiritual problems related to incurable, progressive life-threatening conditions.
To promote understanding and respect towards patients at the end of life and to prevent unnecessary and futile interventions in order to allow a peaceful and dignified death.
To promote education in the field of palliative medicine and palliative care for both healthcare and non-healthcare professionals.
SCOPE OF SERVICE
Covers both cancer and non-cancer patients with a progressive life-threatening illness, including – Medical management of chronic cancer pain and other distressing physical symptoms related to advanced cancer. – Medical management of pain and other distressing physical symptoms related to progressive life-threatening noncancerous illnesses.
End-stage cardiac disease
An end-stage renal disease where dialysis support is not feasible
Progressive neurodegenerative disorders
Severe chronic airway limitation with deteriorating respiratory function and poor candidate for ventilatory support
Life-threatening pediatric conditions
HIV / AIDS not responding to anti-retroviral therapy
Frailty in the elderly with multiple progressive comorbidities.
Provision of psychosocial and spiritual supportive care to patients and families facing life-threatening illnesses.
Provision of terminal care for patients at the end of life.
Provision of respite care for patients and families.
Provision of consultative advice and assistance to other medical colleagues regarding palliative management of patients with life-threatening situations under their care
COMPONENTS OF SERVICE
Inpatient palliative care service.
Out-patient palliative care service.
Consultative palliative care service in general wards.
Consultative palliative care service in other hospitals without \
Palliative care units.
Community palliative care service.
Day palliative care service.
PRINCIPLES OF PALLIATIVE CARE MANAGEMENT
Scope of care: Includes patients of all ages with life-threatening illnesses, conditions, or injuries requiring symptom relief from physical, psychosocial, and spiritual suffering.
Timing of palliative care: Palliative care should ideally begin at the time of diagnosis of a life-threatening condition and should continue through treatment until death and into the family's bereavement.
Patient and family-centered care: The patient and family constitute the unit of care that should be managed as a whole.
PRINCIPLES OF PALLIATIVE CARE MANAGEMENT
Holistic care: Palliative care must Endeavour to alleviate suffering in the physical, psychological, social, and spiritual domains of the patient in order to provide the best quality of life for the patient and family.
Multidisciplinary care: A multidisciplinary team approach is essential to address all relevant areas of patient care.
Effective communication: Good communication skills (including listening, providing information, facilitating decision-making, and coordinating care) are essential tools in palliative care, and healthcare providers must develop these in order to provide effective palliative care.
Knowledge and Skills: Palliative care is active care and requires specific management for specific conditions.
Seamless care: Palliative care is integral to all healthcare settings (hospitals, emergency departments, health clinics, and home care).
Understanding Palliative Care
The goal of palliative care is to help people with serious illnesses feel better. It prevents or treats symptoms and side effects of disease and treatment. Palliative care also treats emotional, social, practical, and spiritual problems that illnesses can bring up. When the person feels better in these areas, they have an improved quality of life. Palliative care can be given at the same time as treatments meant to cure or treat the disease. Palliative care may be given when the illness is diagnosed, throughout treatment, during follow-up, and at the end of life. Palliative care may be offered for people with illnesses, such as Cancer, Heart disease, Lung diseases, Kidney failure, Dementia, HIV/AIDS, and ALS (amyotrophic lateral sclerosis); while receiving palliative care, people can remain under the care of their regular health care provider and still receive treatment for their disease.
Who Gives Palliative Care?
Any healthcare provider can give palliative care. But some providers specialize in it. Palliative care may be given by:
A team of doctors
Nurses and nurse practitioners
Physician assistants
Registered dietitians
Social workers
Psychologists
Massage therapists
Chaplains
Hospitals, home care agencies, cancer centers, and long-term care facilities may offer palliative care. Your provider or hospital can give you the names of palliative care specialists near you.
The Difference between Palliative Care and Hospice
Both palliative care and hospice care provide comfort. But palliative care can begin at diagnosis and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness. Hospice care is most often offered only when the person is expected to live for six months or less.
Palliative Care Include-A a serious illness that affects more than just the body. It touches all areas of a person's life, as well as the lives of that person's family members. Palliative care can address these effects of a person's illness.
Physical problems - Symptoms or side effects include: Pain, Trouble sleeping, Shortness of breath, Loss of appetite, and feeling sick to the stomach Treatments may include: Medicine, Nutritional guidance, Physical therapy, and Occupational therapy, and Integrative therapies.
Emotional, social, and coping problems. Patients and their families face stress during illness that can lead to fear, anxiety, hopelessness, or depression. Family members may take on caregiving, even if they also have jobs and other duties.
Treatments may include Counseling, Support groups, Family meetings, and Referrals to mental health providers.
Practical problems. Some of the problems brought on by illness are practical, such as money- or job-related problems, insurance questions, and legal issues. A palliative care team may: Explain complex medical forms or help families understand treatment choices, Provide or refer families to financial counseling, and Help connect you to resources for transportation or housing.
Spiritual issues. When people are challenged by illness, they may look for meaning or question their faith. A palliative care team may help patients and families explore their beliefs and values so they can move toward acceptance and peace.
Models of Palliative Care Hospice Care – a well-established program to provide patients with a prognosis of six months or less. As delineated within the Medicare Hospice Benefit, these services can be provided in the home, nursing home, residential facility, or on inpatient unit.
Palliative Care Programs – institutional-based programs in the hospital or nursing home to serve patients with life-threatening or life-limiting illnesses. Occur in hospital settings (academic, community, rehabilitation) and skilled nursing facilities. Provide services to patients anywhere along the disease continuum between initial diagnosis and death.
Outpatient Palliative Care Programs
occur in ambulatory care settings to provide continuity of care for patients with serious or life-threatening illnesses.
Community Palliative Care Programs
Occur in communities as consultative teams who collaborate with hospices or home health agencies to support seriously ill patients who have not yet accessed hospice.
Domains of Quality Palliative Care Structure and Processes of Care -
interdisciplinary team assessment based on patient/family goals of care; prognosis; disposition (level of care – inpatient unit, home); safety
Physical Aspects of Care –
pain, dyspnea, nausea/vomiting, fatigue, constipation, performance status, medical diagnoses, medications (add/wean/titrate). Psychological Aspects of Care – anxiety, depression, delirium, cognitive impairment; stress, anticipatory grief, coping strategies; pharm/non-pharm treatment; patient/family grief/bereavement.
Social Aspects of Care –
family/friend communication/interaction/support; caregiver crisis