Palliative Care is most appropriate for patients who will likely die within weeks.
MYTH2:
Pain is a part of dying.
MYTH3:
Treatment stops when palliative care starts.
MYTH4:
Palliative care speeds up the process of dying.
MYTH5:
Raising the topic of palliative care with patients and caregivers robs them of hope.
MYTH6:
Taking pain medications in palliative care leads to addiction.
MYTH7:
Palliative care is only provided in a hospital.
MYTH8:
Morphine is given to speed up the process of dying.
MYTH9:
Palliative care is only for people dying of cancer.
MYTH10:
People in palliative care who stop eating die of starvation.
Common myths include:
Myth: Palliative Care hastens death.
Fact: Palliative Care does not hasten death. It provides comfort and the best quality of life from diagnosis of an advanced illness until end of life.
Myth: It is only for cancer patients.
Fact: Palliative Care can benefit patients and their families from the time of diagnosis of any illness that may shorten life.
Myth: Patients in palliative care who stop eating die from starvation.
Fact: People with advanced illnesses don’t experience hunger or thirst as healthy people do. People who stop eating die of their illness, not of starvation.
Myth: Pain is part of dying.
Fact: Pain is not always part of dying. If pain is experienced near end of life, there are many ways it can be alleviated
https://web.archive.org/web/20211030083004/https://d2y1pz2y630308.cloudfront.net/12425/documents/2019/1/Palliative%20Care.pdf
5 FACTS ABOUT PALLIATIVE CARE
Specialist Level Palliative
Care:
Information for commissioners
April 2016
https://web.archive.org/web/20210516120547/https://www.england.nhs.uk/wp-content/uploads/2016/04/speclst-palliatv-care-comms-guid.pdf
Palliative and
End of Life Care:
A national framework for local action 2015-2020
https://web.archive.org/web/20210516121126/http://endoflifecareambitions.org.uk/wp-content/uploads/2015/09/Ambitions-for-Palliative-and-End-of-Life-Care.pdf
end of life care
The Government Response to the Review of Choice
in End of Life Care
https://web.archive.org/web/20210516121643/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/536326/choice-response.pdf
END OF LIFE CARE
A TOOLKIT FOR HEALTH AND SOCIAL CARE
Updated April 2016
https://web.archive.org/web/20210516121647/https://www.england.nhs.uk/wp-content/uploads/2016/04/nhsiq-comms-eolc-tlkit-.pdf
Care: 2014-16
https://web.archive.org/web/20210516120557/https://www.england.nhs.uk/wp-content/uploads/2014/11/actions-eolc.pdf
A Review of Choice in End of Life Care
https://web.archive.org/web/20210516121655/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/407244/CHOICE_REVIEW_FINAL_for_web.pdf
Great expectations
https://web.archive.org/web/20210516123556/https://www.nuffieldtrust.org.uk/files/2017-02/shifting-the-balance-of-care-report-web-final.pdf
LESS PATHWAY
A REVIEW OF THE
LIVERPOOL CARE
PATHWAY
https://web.archive.org/web/20210516121651/https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf
and Complexity Collaborative (OACC)
Suite of Measures
A Brief Introduction
https://web.archive.org/web/20210516124337/https://www.kcl.ac.uk/cicelysaunders/attachments/Studies-OACC-Brief-Introduction-Booklet.pdf
A Brief Introduction - Version 2
https://web.archive.org/web/20210516124601/https://www.kcl.ac.uk/cicelysaunders/attachments/OACC-Booklet-2015---The-OACC-Suite-of-Measures---.pdf
General indicators of poor or deteriorating health:
☛ Unplanned hospital admission(s).
☛ Performance status is poor or deteriorating, with limited reversibility.(eg. The person stays in bed or in a chair for more than half the day.)
☛ Depends on others for care due to increasing physical and/or mental health problems.
☛ The person’s carer needs more help and support.
☛ The person has had significant weight loss over the last few months, or remains underweight.
☛ Persistent symptoms despite optimal treatment of underlying condition(s).
☛ The person (or family) asks for palliative care; chooses to reduce, stop or not have treatment; or wishes to focus on quality of life.
https://web.archive.org/web/20210122130446/http://www.spict.org.uk/download/the-supportive-and-palliative-care-indicators-tool-2/?wpdmdl=867
The aims of the LCP are;
- To recognise when death is approaching, and when ongoing medical treatment is futile. This is sometimes difficult to do, but the pathway specifies that the team caring for the patient, including at least one senior doctor, should be in agreement that this is the case.
- To assess the patient for common symptoms at the end of life, and to treat these appropriately.
- To communicate effectively with the patient and their friends and family, to ensure that their wishes are respected as far as possible.
- To respect a patient’s spiritual needs.
- To review whether current interventions are in the patient’s best interests, for example continuing with blood testing, intravenous drugs and oxygen therapy.
https://www.ncbi.nlm.nih.gov/books/NBK356023/#ch1.s1
in managing a broad range of symptoms.
If pain is experienced near end of life,
there are many ways it can be alleviated.
Appropriate doses of morphine keep
patients comfortable but do not hasten
death. The founding tenet of palliative care
is to neither hasten nor postpone death.
People with advanced illnesses don’t
experience hunger or thirst as healthy
people do. People who stop eating die of
their illness, not starvation.
Allowing children to talk about
death and dying can help them develop
healthy attitudes that can benefit them
as adults. Like adults, children also need
time to say goodbye to people who are
important to them.
Palliative care can be provided
wherever the person lives – home, longterm
care facility, hospice or hospital.
WORKSHOP:
https://www.appm.org.uk/_webedit/uploaded-files/All%20Files/Event%20Resources/2020%20APPM%20Master%20Formulary%202020%20protected.pdf
Pelatihan Perawatan Paliatif pada Pasien Stroke
https://drive.google.com/file/d/1Qvju5kkbNoWqyUL12tmI2WY0rnixduRv/view?usp=sharing
Edmonton Symptom Assessment System (ESAS-r)
- Pain – grimacing, guarding against painful maneuver
- Tiredness – increased amount of time spent
- Drowsiness – decreased level of alertness
- Nausea – retching or vomiting
- Appetite – quantity of food intake
- Shortness of breath – increased respiratory rate or effort that appears to causing distress to the patient
- Depression – tearfulness, flat affect, withdrawal from social interactions, irritability, decreased concentration and/or memory, disturbed sleep pattern
- Anxiety – agitation, flushing, restlessness, sweating, increased heart rate (intermittent), shortness of breath
- Wellbeing – how the patient appears overall
- https://web.archive.org/web/20171009233613if_/http://www.palliative.org/NewPC/_pdfs/tools/ESAS-r.pdf
Effective ways to communicate with the patient are:https://www.capc.org/training/symptom-management/depression/launch/
- Make eye contact
- Take time
- Listen
- Ask open-ended questions such as, "How are you feeling?"
- Avoid asking closed-ended (yes or no) questions or interrupting the patient
https://www.gmmh.nhs.uk/download.cfm?doc=docm93jijm4n7159.pdf&ver=9697
MEDICATIONS USED FOR SUBCUTANEOUS INFUSION
https://pharmacopallcare.blogspot.com/2020/09/medications-used-for-subcutaneous.html
Pain can be divided into nociceptive and neuropathic types of pain.
Pain can be a mixture of these two types.
Nociceptive pain:
☛ Caused by invasion and destruction of or pressure on superficial somatic structures like skin, deeper skeletal structures such as bone and muscle and visceral structures and organs.
☛ Types: superficial, deep, visceral
☛ Superficial and deep nociceptive pain is usually localized and non-radiating.
☛ Visceral pain is more diffuse over the viscera involved.
Neuropathic pain:
☛ Caused by pressure on or destruction of peripheral, autonomic or central nervous system structures.
☛ Radiation of pain along dermatomal or peripheral nerve distributions
☛ Often described as burning and/or deep aching.
☛ May be associated with dysesthesia, hypesthesia, hyperesthesia and allodynia.
☛May also be accompanied by lightning like jabs of brief sharp pain (lancinating pain).
Everyone deserves ‘a good death’
and this is more likely to be achieved by discussing it early on.
Every individual will have a different idea about what would constitute ‘a good death’ for them.
This may involve:
☛ Being treated as an individual, with dignity and respect.
☛ Being without pain and other symptoms.
☛ Being in familiar surroundings.
☛ Being in the company of close family and/or friends.
https://web.archive.org/web/20200811123428/https://rcni.com/sites/rcn_nspace/files/aop_ns.2016.e10099.pdf
Guidance At End of Life (GAEL) for Health Care Professionals
https://palliativecareindonesia.blogspot.com/p/guidance-at-end-of-life-gael-for-health.html
Hospice and palliative care is about having the best quality of life for however long life remains. Palliative care patients have serious illnesses that eventually bring about the end-of-life but up until then it is important to be free from pain, symptoms, and suffering. Recent studies show that many patients who receive palliative care may live longer than those receiving standard care based on a more curative model.
http://www.adultpalliativehub.com/who-we-are/about-adult-palliative/palliative-care-myths
Examples of appropriate medication for anticipatory ‘as required’ prescribing:
• Opioid analgesic subcutaneous (SC), hourly as required; dose depends on the patient, clinical problem and previous opioid use.
1/6th of 24 hour dose of any regular opioid.
If not on a regular opioid, prescribe morphine sulphate SC 2.5mg to 5mg hourly.
• Anxiolytic sedative: midazolam SC 2.5mg to 5mg, hourly.
• Anti-secretory medication: hyoscine butylbromide (Buscopan) SC 20mg, hourly.
• Anti-emetic: haloperidol 1.5mg SC, 12 hourly.
The principles governing analgesic use are summarised in the WHO Method for Relief of Cancer Pain:
• By mouth, where possible.
• By the clock: Regular, as well as p.r.n. dose.
• By the ladder:
- After assessing the severity of pain, the analgesic ladder can be used to identify appropriate analgesics for the level of pain.
- The patient should be reassessed and analgesia administered in a step-wise manner working up the ladder until the patient’s pain is managed.
- Similarly, if the severity of pain is reduced, a patient’s level of analgesics should move back down the ladder.
• Alternative analgesia and adjuvants or non-pharmacological interventions should be considered at each level of the analgesic ladder.
• Individual dose titration: Titrate dose against effect, with no rigid upper limit for most opioids except buprenorphine, codeine and tramadol. However, please consider specialist referral in high dose opioids (>120mg oral morphine equivalent/ 24hours) and inadequate pain control.
The total pain experience: an interactive model.
‘How people die remains in the memory of those who live on’
Dame Cicely Saunders, Founder of the modern hospice movement
‘Every person in the last days of their life regardless of who they are, where they are or who cares for them has the right to receive high quality care given with compassion and skill.
Every person in the last days of their life regardless of who they are, where they are or who cares for them should expect that their loved ones receive high quality support given with compassion and skill.‘
Kat Collett, Consultant in Palliative Medicine, Lincolnshire.
Making the most of Life
… before I die
As Muslims approach death, they may be encouraged by relatives or religious authority figures to recite the declaration of faith (Shahada). If possible, the patient is turned to face toward Mecca. Depending on the orientation of the bed in the room, visitors present may move or rearrange the furniture.
https://www.woolf.cam.ac.uk/outreach/healthcare
Palliative care is comfort care.
There are two current mainstream avenues in offering palliative care.
First, hospice care offers palliative care. When there is no cure and comfort is sought, hospice care provides palliative care when prognosis is months.
Second, typically offered in palliative care units and often times in connection with hospital services, palliative care is offered to chronically ill individuals where there may or may not be a cure, but prognosis can be years.
https://www.baxterregional.org/centers-and-off-site-services/palliative-care/
