Principles underlying the palliative approach to care include:
1. Attention to symptom management and the relief of suffering
2. Providing psychosocial and spiritual care
3. Focusing on quality of life
4. Caring for both the person and chosen family/caregivers, including during bereavement if needed
5. Multidisciplinary team approach
6. Involvement early in the illness trajectory alongside curative treatment
7. Living well until death, accepting death as a natural part of life
https://web.archive.org/web/20200913041224/http://bc-cpc.ca/cpc/wp-content/uploads/2019/02/2019-02-22-Integration-of-a-PAC.pdf
CAREGIVERS
Caregivers may be defined
as unpaid, informal providers
of one or more physical,
social, practical, and emotional tasks.
In terms of their relationship
to the patient,they may be a friend,
partner, ex-partner, sibling,
parent, child, or other blood
or non-blood relative.
https://www.tandfonline.com/doi/full/10.1179/1743291X13Y.0000000056
Palliative care allows for medical therapies, but focuses on:
- Improving quality of life
- Relieving symptoms (for example pain) and stress
- Reaching the best possible function (for example, daily activities, physical activity, and self-care)
- Helping with decision-making about end-of-life care
- Providing emotional support to patients and their families
Did you know...
https://training.caresearch.com.au/learner/course/viewcourse/lid,0/cid,10019/pid,10843
Joint Declaration and Statement of Commitment on Palliative Care and Pain Treatment as Human Rights
1. Identify, develop and implement strategies for the recognition of palliative care and pain treatment as fundamental human rights.
2. Work with governments and policy makers to adopt the necessary changes in legislation to ensure appropriate care of patients with life-limiting conditions.
3. Work with policy makers and regulators to identify and eliminate regulatory and legal barriers that interfere with the rational use of controlled medications.
4. Advocate for improvements in access to and availability of opioids and other medications required for the effective treatment of pain and other symptoms common in palliative care, including special formulations and appropriate medications for children.
5. Advocate for adequate resources to be made available to support the implementation of palliative care and pain treatment services and providers where needed.
6. Advocate for academic institutions, teaching hospital and universities to adopt the necessary practices and changes needed to ensure that palliative care and pain positions, resources, personnel, infrastructures, review boards and systems are created and sustained.
7. Encourage and enlist other international and national palliative care, pain treatment,related organizations, associations, federations and interested parties to join this global campaign for the recognition of palliative care and pain treatment as human rights.
https://www.tandfonline.com/doi/full/10.1080/15360280802537274
Advance care planning is defined as discussing and planning for care in
the future when the person may no longer have decision-making capacity.
Lactulose
Use:
- Constipation, faecal incontinence related to constipation.
- Hepatic encephalopathy (portal systemic encephalopathy) and coma.
Dose:
Constipation:
By mouth: initial dose twice daily then adjusted to suit patient
- Neonate: 2.5 mL/dose twice a day
- Child 1 month-11 months: 2.5 mL/dose 1-3 times daily
- Child 1year-4 years: 5 mL/dose 1-3 times daily
- Child 5-9 years: 10 mL/dose 1-3 times daily
- Child 10-17 years: 15 mL/dose 1-3 times daily.
Hepatic encephalopathy:
- Child 12-17 years: use 30-50mL three times daily as initial dose. Adjust dose to produce 2-3 soft stools per day.
- Licensed for constipation in all age groups. Not licensed for hepatic encephalopathy in children.
- Increases colonic bacterial flora (macrogols do not).
- Side effects may cause nausea and flatus, with colic especially at high doses. Initial flatulence usually settles after a few days.
- Precautions and contraindications; Galactosaemia, intestinal obstruction. Caution in lactose intolerance.
- Use is limited as macrogols are often better in palliative care. However the volume per dose of macrogols is 5-10 times greater than lactulose and may not be tolerated in some patients.
- Lactulose is less effective than macrogols, or sodium picosulfate for opioid induced constipation in ambulatory palliative care patients.
- Sickly taste.
- Onset of action can take 36-48 hours.
- May be taken with water and other drinks.
- May be administered via NG tube or gastrostomy. Dilution with 2-3x the volume of water will reduce the viscosity of the solution and aid administration. As the site of action is the colon, lactulose will have a therapeutic effect if it is delivered directly into the stomach or jejunum. Administer using the above method.
- 15 mL/day is 14 kcal so unlikely to affect diabetic or ketogenic diets.
- Does not irritate or directly interfere with gut mucosa.
- Available as oral solution 10 g/15 mL or 680 mg/1 mL. Cheaper than Movicol (macrogol).
https://www.appm.org.uk/guidelines-resources/appm-master-formulary/
Management of Ascites in Palliative Care
https://bit.ly/AscitesPC
Managing pain and other symptoms - End of life care
- It can feel very difficult to speak about your illness or the fact you're dying, but talking with your loved ones can help. You or your family and friends may even find it a relief to have the subject out in the open, even if you find it upsetting.
- Not talking can create worries or distance between you and the people who are important to you, even if you are usually very close. Talking about your illness and death can help you feel closer and more able to deal with the future and your worries together.
https://idhdp.com/media/362593/palliat-med-2014-cleary-291-2.pdf
https://www.who.int/selection_medicines/committees/expert/19/applications/PalliativeCare_8_A_R.pdf
https://www.sahealth.sa.gov.au/
Management of Constipation in Adult Patients Receiving Palliative Care
https://www.gov.ie/en/collection/b34c3e-management-of-constipation-in-adult-patients-receiving-palliative-ca/
- http://centralhpcnetwork.ca/hpc/HPC_docs/formsref/Collaborative_Care_Plan_Stable.pdf
- https://acclaimhealth.ca/wp-content/uploads/2019/01/Collaborative-Care-Plan-Transitional.pdf
- https://acclaimhealth.ca/wp-content/uploads/2019/01/Collaborative-Care-Plan-End-of-Life.pdf
- http://www.centralhpcnetwork.ca/hpc/HPC_docs/formsref/Collaborative_Care_Plan_Condensed%20Version.pdf
- https://www.ontariopalliativecarenetwork.ca/sites/opcn/files/OPCNToolsToSupportEarlierIdentificationForPC.pdf
Key points to consider in the pharmacological management of end-of-life (terminal) symptoms include:
- Confirm the patient and/or their Substitute Decision Maker (SDM) are aware that the patient is dying and support the use of medicines to manage end-of-life (terminal) symptoms.
- Prescribe medicines based on careful assessment of the dying patient's condition and symptoms.
- Regularly reassess treatment so the doses are proportionate to the severity of symptoms.
- Cease any medications that have minimal therapeutic benefit in the terminal phase of life.
- Consider the burden associated with how medicines are given, minimising the potential for side effects.
- Consider administering medicines via the subcutaneous route - the least invasive and most reliable route in the dying.
- Write up PRN orders for intermittent symptoms and to cover possible breakthrough events for persistent symptoms.
- Ensure that medicines are easily accessible when needed by writing up the medicines in advance (see Anticipatory prescribing).
- Identify the cause of problems and then manage in the context of the patient's preferences: remembering some things are irreversible and are a part of the dying process.
- advanced, progressive, incurable conditions
- general frailty and co-existing conditions that mean they are expected to die within 12 months existing conditions
- if they are at risk of dying from a sudden acute crisis in their condition
- life-threatening acute conditions caused by sudden catastrophic events.
• Anorexia
• Anxiety
• Constipation
• Delirium
• Depression
• Diarrhoea
• Dyspnea
• Fatigue
• Nausea and vomiting
• Pain
• Respiratory tract secretions
Oooookay kan, Bro!
