A patient will be considered to have a life expectancy of six months or less if
he/she meets the non-disease specific decline in clinical status.
Alternatively, the non-disease specific, plus the applicable
disease-specific guidelines, can also establish the necessary
expectancy.
https://www.montgomeryhospice.org/health-professionals/end-stage-indicators/end-stage-indicators
TRAINEES MANUAL
TRAINER’S MANUAL
TRAINING CURRICULUM
Continuous Subcutaneous Infusions (CSCI) in Palliative Care
https://bit.ly/CSCIinPalliativeCare
- “Individuals confronting grave illnesses, severe pain or impairment, and mortality must manage their hopes and fears and consider critical factors such as being comfortable, controlling finances, having food and shelter, being connected with others, honoring their family and social role, and being right with their spiritual commitments.
- “Patients and physicians are often confused by this unfamiliar situation.”
- However, a focus on measuring clinical management of physical symptoms, in determining value-for-money, means these non-clinical outcomes – like being able to arrange funerals, write wills and advance care directives, and hand tasks to family members – are often overlooked.
Palliative sedation is not a euphemism that is morally equivalent to euthanasia, nor is it “slow euthanasia,” or physician-assisted suicide (PAS). There is a sharp distinction between euthanasia and PS or PAS and PS, the distinction between the three can be ascertained by recognizing the primary intention and outcome of each measure. Although PAS and euthanasia are intended to relieve suffering, it is accomplished by causing death, whereas PS is provided in a proportionate manner without an intention of causing death.
https://www.nationalreview.com/human-exceptionalism/palliative-sedation-not-terminal-sedationeuthanasia-wesley-j-smith/Key messages
https://www.bmj.com/content/356/bmj.j878.full
- Palliative care should start at diagnosis and not be confined to the very end of life
- Early palliative care improves quality of life by focusing on living well with deteriorating health
- All health professionals need to incorporate holistic palliative care into their practice
- An understanding of typical, multidimensional illness trajectories can help doctors know what to offer and when
“A good death is the best death that can be achieved in the context of the individual’s clinical diagnosis and symptoms, as well as the specific social, cultural and spiritual circumstances, taking into consideration patient and carer wishes and professional expertise.”
Kematian yang baik adalah kematian terbaik yang dapat dicapai dalam konteks diagnosis dan gejala klinis individu, serta keadaan sosial, budaya dan spiritual tertentu, dengan mempertimbangkan keinginan pasien dan pengasuh serta keahlian profesional.
https://web.archive.org/- “Palliative care is important because it gives patients a voice to participate in their medical care and decision making. It honors them and their autonomy. It helps patients choose and receive care they want and need,” Dr. Nordstrom says.
- Palliative medicine can also help patients plan for the future. Dr. Nordstrom compares a serious illness to a long, hard trip, saying no one would reasonably embark on a difficult trip without some advanced planning and preparations. In the same way, palliative medicine helps patients and families plan for their individual illness.
Referral to palliative care medical specialists can only be initiated by another doctor. The palliative care medical specialist will then contact the person seeking palliative care and their family to arrange a consultation. this consultation could be in an outpatient clinic, inpatient facility or the person's home.
https://www.dhhs.tas.gov.au/service_information/information/palliative_care_referral_criteriaLiving, Dying & Grieving Well: A guide to palliative care
https://www.pallcarevic.asn.au/library-media/living-dying-grieving-well-a-guide-to-palliative-care/
- Palliative care is for anyone with a life-limiting illness who needs specialist support. It can help people with a wide range of conditions, such as cancers, chronic diseases, dementia, and degenerative conditions.
- People of all ages, cultures and beliefs can receive palliative care.
- Not everyone who receives palliative care is about to die. Some people live with their condition for a long time, others have periods of wellness, and some may recover. People can move in and out of palliative care as their needs change.
- Hope continues to be important – what one hopes for, however, may change.
The SQ (surprise question) is intended to be a simple and feasible screening test to identify patients with hospice and palliative care needs, but it performs poorly to modestly when used to predict death at 6 to 18 months, with poorer performance among patients with noncancer illness. Based on these findings, the SQ should not be used as a stand-alone prognostic tool
https://www.cmaj.ca/content/cmaj/189/13/E484.full.pdf
Patients with diabetes who are at the end of life, have a unique set of care needs, including those relating to health and social care. However end-of-life diabetes care has been recognised as an area lacking quality standards and guidance on best clinical practice.
https://www.diabetes.org.uk/
Generally, a ‘good death’ means that the dying person was treated with dignity, compassion and respect by their care workers and was kept clean and comfortable in familiar surroundings with people who were important to them close by.
https://www.carehome.co.uk/advice/what-is-end-of-life-care-and-what-does-it-involve
Generally speaking, people who are dying need care in four areas—physical comfort, mental and emotional needs, spiritual issues, and practical tasks. Their families need support as well.
https://www.nia.nih.gov/health/providing-comfort-end-life
The term “serious illness” is important to palliative care professionals. For years, doctors have defined palliative care as a form of care for patients with “advanced illness.” This has furthered the stigma that palliative care is only reserved for patients who are “at the point of no return,” which is untrue, Dr. McPherson explained.
https://www.practicalpainmanagement.com/resources/hospice/defining-palliative-careIf it is thought that a person may be entering the last days of life, gather and document information on:Assess for changes in signs and symptoms in the person and review any investigation results that have already been reported that may suggest a person is entering the last days of life.
- The person's physiological, psychological, social and spiritual needs
- Current clinical signs and symptoms
- Medical history and the clinical context, including underlying diagnoses
- The person's goals and wishes
- The views of those important to the person about future care
https://www.guidelinecentral.com/
Palliative care is
the care of patients with active, progressive, far-advanced disease,
for whom the focus of care is the relief and prevention of suffering and
the quality of life.
The following should be noted:
- 1. active disease: this activity can be confirmed and measured objectively by clinical examination and investigations;
- 2. progressive disease: this too can be assessed clinically;
- 3. far-advanced disease: more difficult to define but examples are extensive metastatic disease in cancer, refractory cardiac, renal or respiratory failure and total dependency in neurodegenerative conditions or Alzheimer's Disease;
- 4. focus on the quality of life is the key feature of the definition
- 5. it is person-oriented, not disease-oriented;
- 6. it is not primarily concerned with life prolongation (nor with life shortening);
- 7. it is not primarily concerned with producing long term disease remission;
- 8. it is holistic in approach and aims to address all the patient's problems, both physical and psychosocial;
- 9. it uses a multidisciplinary or inter professional approach involving doctors, nurses and allied health personnel to cover all aspects of care;
- 10. it is dedicated to the quality of whatever life remains for the patient
- 11. palliative care is appropriate for all patients with active, progressive, far-advanced disease and not just patients with cancer;
- 12. palliative care is appropriate for patients receiving continuing "active" therapy for their underlying disease.
Medical model
- Focus on diseases only
Most of the time, individual approach to evaluate
Respond to physical pain
Pain relief in physical level
Support system low level
Low level satisfaction
Medico-psycho-sociospiritual model
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140083/
- Focus on the whole person body, mind, and spirit
Team approach to evaluate
Respond to total pain
Pain relief in all levels
Increase in support system
High level satisfaction
Palliative
care should never be withheld until such time that all "active"
treatment regimens for the underlying disease have been exhausted.
The
message of palliative care is that whatever the disease, however
advanced it is, whatever treatments have already been given, there is
always something which can be done to improve the quality of the life
remaining to the patient.
https://hospicecare.com/what-we-do/publications/getting-started/5-what-is-palliative-care
The “palliative” term derives from Latin word pallium meaning to ‘mask’ or ‘cloak’ The
idea was that palliative care could protect and cover those patients
who are “left out in the cold” curative medicine could no longer treat
them. Doctor Balfour Mount introduced the term ‘palliative care’ in 1973
when, after visiting St Christopher’s Hospice in London, he opened a
new hospital ward for terminally ill patients at the Royal Victoria
Hospital, in Montreal, Canada. Dr. Mount was hesitant of using the term
“hospice” because in France the word had a negative connotation that
suggested mediocrity of care.
The terms “palliative care” and “hospice care” have been used to mean a variety of different things.
Historically, “hospices”
were places of temporary or permanent stay, including homes for the
destitute, for orphans, for pilgrims, and for the dying who had no one
else to care for them. The word "hospice" derives from the Latin hospes, a word that includes host, guest or stranger. In some countries such as the United Kingdom, “hospice”
is a free-standing palliative care inpatient unit, while in Germany and
the USA it tends to be a unit run by volunteers or home care programs
for patients at the end of life. In France, a “hospice” still refers to a refuge for travelers needing food and shelter, and in Germany and Israel may even mean “hotel”.
https://hospicecare.com/uploads/2019/9/PC%20Definition%20-%20online%20supplement%20material%20for%20IAHPC%20website.pdf
When a person approaches end of life, palliative care becomes increasingly important to ensure quality, coordinated care and symptom management.There are four distinct aspects needed for full renal EOL program development. These are:
https://bc-cpc.ca/cpc/all-resources/
Whether you are in the midst of a serious illness, or want to plan ahead for future health-care needs, these resources and information can help.
https://bc-cpc.ca/cpc/all-resources/individuals/
The Compassionate Community Toolkit guides organizations and groups interested in building a caring, supportive network for people affected by serious illness, end of life, care-giving, and grieving.
https://bc-cpc.ca/cpc/
- patient identification
- symptom assessment and management
- advance care planning process
- care in the final stages, including grief and bereavement.
Medical Definition of palliative care: medical
and related care provided to a patient with a serious,
life-threatening, or terminal illness that is not intended to provide
curative treatment but rather to manage symptoms, relieve pain and
discomfort, improve quality of life, and meet the emotional, social, and
spiritual needs of the patient
Many
still believe palliative care is appropriate only when nothing more can
be done to treat a patient's disease and prolong life. But unlike
hospice, palliative care can and should be delivered while patients
continue treatment for their diseases.— Jane E. Brody, The New York Times, 3 Dec. 2013
https://www.merriam-webster.com/medical/palliative%20carehttps://bjaed.org/article/S1743-1816(17)30528-0/fulltext
- In 1987, Ventafridda and colleagues demonstrated, in a retrospective study, that the use of the WHO analgesic ladder for all cancer pain led to a reduction in pain intensity in 71% of patients.
- Therefore, nearly a third of patients may need additional pharmacological and psychological management. This often requires the use of adjuvant analgesics.
- Anti-depressants may be useful; older less specific drugs such as amitriptyline are more effective than the newer drugs that target fewer receptor sites (e.g. fluoxetine).
At times when death is a greater threat,
clinicians should have a conversation
about the patient’s status
and available interventions
to either allow natural death
or attempt to forestall death.
Because the patient is often new
to the clinician at such encounters,
the conversation should begin
by asking
what the patient understands and expects.
A conversation about dying is
nearly always a ‘‘bad news conversation.’’
Clinicians should acknowledge
that the topic is sad or distressing,
and learn to provide empathetic responses
to patients or families.
Examples of empathetic responses
include identifying emotions
both on the clinician’s
and patient’s parts,
and using ‘‘wish’’ statements
such as
‘‘I wish things were different.’’
‘‘Ask-Tell-Ask’’ Methodology
Ask
‘‘Tell me what you believe is going on in your illness’’
‘‘As you look back, what has been important in your life?’’
‘‘What are your concerns and worries?’’
Tell and Partner
‘‘Heart failure is a disease that can last for years, but
that most people die from. My goal is to work with
you to do our best to help you ____’’
Ask ‘‘What are your questions?’’
‘‘Tell me what you understood from our discussion.’’
Journal of Cardiac Failure Vol. 20 No. 2 February 2014
Ooookay kan, Bro!
