Palliative care is designed to relieve the symptoms of a disease rather than to cure it. It's considered when a cure for a life-limiting illness is not an option or when the client becomes so frail that death will be the outcome. There is no fixed point in a person's life at which a palliative approach should commence, as each client will experience deterioration in their health differently.
https://www.pallcaretraining.com.au/mod/page/view.php?id=12
Care should be based on the assessed needs of the patient, the carers or family and not solely on their diagnosis or other fixed criteria
https://www.aci.health.nsw.gov.au/palliative-care-blueprint/the-blueprint/essential-components/essential-component-5
Identifying that a person may be dying is
an important step in recognising
when restorative treatment aims are
appropriate and, equally,
it allows time to plan and deliver effective EOL care.
Recognition systems should aim
to identify people at two critical points:
· when a person is likely to die in the medium term (within the next 12 months), where episodes of acute clinical deterioration may be reversible; and
· when a person is likely to die in the short term (within days to weeks), and clinical deterioration is likely to be irreversible (ACSQHC 2015).
Supportive and palliative care
https://www.uhb.nhs.uk/supportive-and-palliative-care.htm
https://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/For+Professionals/For+Professionals.aspx
Measurement and Evaluation Tools
http://www.npcrc.org/content/25/Measurement-and-Evaluation-Tools.aspx
Symptom Management Guidelines Linked resources & tools for care providers
https://www.archhospice.ca/symptom-management
https://library.nshealth.ca/PalliativeCare
- Greater Choice for At Home Palliative Care measure
- Comprehensive Palliative Care in Aged Care measure
- PCC4U promotes the inclusion of palliative care education as an integral part of all medical, nursing, and allied health undergraduate and entry to practice training, and ongoing professional development.
- Learn More About PEPA
- The Guidelines for a Palliative Approach to Aged Care in the Community (COMPAC)
- Palliative Care Outcomes Collaboration
- Advance care planning promotes care that is consistent with a person's goals, values, beliefs and preferences.
- Clinical Evidence
- palliAGED is the palliative care evidence and practice resource for aged care.
- The education is free to use, evidence based and has been peer reviewed by doctors, nurses and allied health professionals around Australia.
- Better primary health care through team-based initiation of advance care planning and palliative care
- Resources are applicable Australia-wide for community service providers, health professionals and carers to support carers to help manage breakthrough symptoms safely using subcutaneous medicines.
- Most modules include information about helpful website resources. Here is a full list for your convenience.
- End of Life Directions for Aged Care (ELDAC)
- Palliative Care Education and Training Collaborative End of Life Law for Clinicians
- Report on research done into the awareness and attitudes of GPs towards palliative care.
- Australian Government response to the Senate Community Affairs References Committee report: Palliative Care in Australia
- The Palliative Care Needs Assessment Guidance
Experts have agreed that there are 5 important priorities for the care and support that you and your carers can expect to receive in the last few days and hours of life.
- 1. You should be seen by a doctor regularly and if they believe you will die very soon, they must explain this to you and the people close to you.
- 2. The staff involved in your care should talk sensitively and honestly to you and the people close to you.
- 3. You and the people close to you should be involved in decisions about how you are treated and cared for, if this is what you want.
- 4. The needs of your family and other people close to you should be met as far as possible.
- 5. An individual plan of care should be agreed with you and delivered with compassion.
Palliative care is a speciality that is increasingly focused upon in modern medicine, and we can hope that doctors will become even better at treating the pains we often suffer towards the end of our lives.
https://link.springer.com/article/10.1007/s11019-019-09914-6
Heidegger thus considers that knowledge about death leads to understanding of Existence and that knowledge of Existence will result in knowing the universe.
https://www.sciencedirect.com/science/article/pii/S2405883116300077
Everyone’s experience of dying is different, and some people will die suddenly or unexpectedly. But in most cases, there are some signs that can help you to recognise when someone is entering the terminal phase. These include:
- getting worse day by day or hour by hour
- reduced mobility, or becoming bed-bound
- extreme tiredness and weakness
- needing assistance with all personal care
- little interest in getting out of bed
- little interest in food or drink
- difficulty swallowing oral medication
- being less able to communicate
- not wanting to socialise
- sleepiness and drowsiness
- reduced urine output
- new incontinence
- increased restlessness, confusion, and agitation
- changes in their normal breathing pattern
- noisy chest secretions
- mottled skin and feeling cold to the touch
- the person may tell you that they feel as if they are dying.
http://endoflifecareambitions.org.uk/
Licensing
- Suggested that 50% or more of medicines used in children are not licensed for purpose (even greater in palliative care)
- Off-label (e.g. not licensed in children, unlicensed route of administration, unlicensed dose, use outside licensed age limits, unlicensed indication)
- Unlicensed (any manipulation of the original dosage form; use of ‘specials’, imported medicines)
- GMC advice(prescribers must be satisfied there is sufficient evidence / experience of using an off-label or unlicensed medicine to demonstrate its safety and efficacy)
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf
- The Liverpool care pathway is to be abolished following a government-commissioned review which heard that hospital staff wrongly interpreted its guidance for care of the dying, leading to stories of patients who were drugged and deprived of fluids in their last weeks of life.
- The government-commissioned review, headed by Lady Neuberger, found it was not the pathway itself but poor training and sometimes a lack of compassion on the part of nursing staff that was to blame, while junior doctors were expected to make life-and-death decisions beyond their competence after hours and at weekends. The review says individualised end-of-life care plans must be drawn up for every patient nearing that stage.
- "Caring for the dying must never again be practised as a tickbox exercise and each patient must be cared for according to their individual needs and preferences, with those of their relatives or carers being considered too," said Neuberger. "Ultimately it is the way the LCP has been misused and misunderstood that had led to such great problems."
“Dying with dignity”: indicates a death that occurs within the broad parameters set forth by the patient with respect to how they wish to be cared for at the end of life. It is NOT synonymous with euthanasia or physician-assisted death.
Euthanasia: means knowingly and intentionally performing an act, with or without consent, that is explicitly intended to end another person's life and that includes the following elements: the subject has an incurable illness; the agent knows about the person's condition; commits the act with the primary intention of ending the life of that person; and the act is undertaken with empathy and compassion and without personal gain.
Medical aid in dying: refers to a situation whereby a physician intentionally participates in the death of a patient by directly administering the substance themselves, or by providing the means whereby a patient can self-administer a substance leading to their death.
https://web.archive.org/web/20200812124646/https://www.covenanthealth.ca/media/123343/vii-b-440.pdfhttps://web.archive.org/web/20200812124646/https://www.covenanthealth.ca/media/123343/vii-b-440.pdf
What is the relationship between curative and palliative care?
The aim of palliative care is to relieve suffering
in order to improve quality of life
for those with serious health related suffering.
Persons receiving palliative care have a right
to choose their treatments
and may also receive curative treatments
or interventions alongside palliative treatment.
Palliative care professionals closely monitor symptoms
and will advise if curative treatments may be adding
to the person’s suffering
thus allowing them to make informed choices
as illness progresses or improves
CARE NEEDS OF PATIENTS WITH ADVANCED-STAGE CANCER
A The care needs of a patient with cancer can be classified
under three domains:
cancer management;
symptom management and personal care needs;
and the management of comorbidities.
Considerable interactions exist
between these domains and,
therefore,
interventions relating to
one domain of care can influence
the needs pertaining to another (arrows),
which necessitates dynamic monitoring
of the patient
and modification of their care.
For instance,
chemotherapeutic agents can cause renal failure,
which requires the initiation
of different medical interventions
and can also affect the ability
of the patient to proceed
with oncological investigations
and treatments.
Disease progression might affect
the emotional state of the patient,
which might, in turn,
affect her adherence to treatment.
To optimize patient outcomes,
the oncology team,
palliative-care team,
primary-care team,
and other subspecialists need
to collaborate closely
and communicate often.
B Personal care needs can be further
subdivided into
acute issues,
chronic issues,
psychosocial issues,
and existential and spiritual issues.
Relevant expertise,
close collaboration
and interdisciplinary teamwork,
and adequate resources are
important requirements
to comprehensively address
these supportive-care issues,
longitudinally.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772864/pdf/nihms762195.pdf
Ooookay kan, Bro!
