☀ ☀ EDUCATION AND TRAINING FRAMEWORK

Palliative Care: WHO IS IT FOR, WHAT DOES IT DO, WHY SHOULD I WANT IT AND WHEN?

 

 

Palliative care comes from the word “palliate” - which means to ease.

Why Recent Focus on Palliative Care?
    • We are maturing as a society both in age and in terms of thinking
    • People are more involved in their care
    • Financial
    • Multiple studies: palliative care helps improve quality of care and is more cost effective.
    
https://intermountainphysician.org/intermountaincme/Documents/01_McNally%20Palliative%20Care%20101.pdf

End of life core skills education and training framework

Supporting someone who may be approaching the end of their life can be some of the most challenging work that any social care or health worker faces. This means that staff need the right skills and knowledge to do their job competently and confidently, and the right learning and development can help.

https://www.skillsforcare.org.uk/Learning-development/ongoing-learning-and-development/end-of-life-care/End-of-life-care.aspx

Research and analysis End of life care: research into community-based initiatives

A qualitative research report on public perceptions and experiences of community-based end of life care initiatives.

https://www.gov.uk/government/publications/end-of-life-care-research-into-community-based-initiatives

Official Statistics End of life care profiles: July 2019 data update
The profiles provide an overview of end of life care in England at various geographies.
https://www.gov.uk/government/statistics/end-of-life-care-profiles-july-2019-data-update

Research and analysis The role of care homes in end of life care
Research and analysis
The role of care homes in end of life care
Residential and nursing home data including availability of places, number of deaths, and demographics of people who receive end of life care.
https://www.gov.uk/government/publications/the-role-of-care-homes-in-end-of-life-care

https://web.archive.org/web/20210617131805/https://anzgmu.com.au/wp-content/uploads/2021/04/5.-What-do-I-need-to-know-about-Pall-Care.pdf

SKIN WOUND

 

The list below provides the foundation for estimating the probability for any skin wound to successfully respond to aggressive local intervention (including surgical closure) that seeks to close the wound(s). The more items checked on the list, the less likely that the wound(s) will achieve a sustainable complete closure.

HEALING PROBABILITY ASSESSMENT TOOL

- Wound(s) is over 3 months old, or is a reoccurrence of a pre-existing breakdown
- Patient spends 20 or more hours of a day in a dependent position. (chair or bed)
- Patient is incontinent of urine
- Patient is incontinent of feces
- Patient has lost >5% of baseline weight, or 10 pounds, in the past 90 days
- Patient does not eat independently
- Patient does not walk independently
- Patient has a history of falls within last 90 days
- Patient is unable/unwilling to avoid placing weight over wound(s) site(s)
- Wound is associated with complications of diabetes mellitus
- Wound is associated with peripheral vascular disease (PVD)
- Severe chronic obstructive pulmonary disease (COPD)
- End stage renal, liver, or heart disease
- Wound is associated with arterial disease
- Patient has diminished range of motion (ROM) status non-responsive to
rehabilitative services
- Patient has diminished level of mental alertness demonstrated by muted
communication skills and inability to perform activities of daily living (ADLs)
independently
- Wound is full thickness, with presence of tunneling
- Blood values indicate a low oxygen carrying capacity
- Blood values indicate an exhausted or decreasing immune capacity (i.e., low
lymphocyte count)
- Blood values indicate below normal visceral protein levels that have not
responded to nutritional support efforts (i.e., low prealbumin, transferrin, retinol-binding protein, and albumin)

https://web.archive.org/web/20210611132539/http://www.manukahonning.no/uploads/3/9/6/3/39639435/_palliative_wound_care_and_healing_probability_assessment_tool.pdf

 

GLOBAL LEVELS OF PALLIATIVE CARE DEVELOPMENT

https://www.researchgate.net/profile/Stephen_Connor6/publication/337442942_Mapping_Levels_of_Palliative_Care_Development_in_198_Countries_The_Situation_in_2017/links/5dfa3b954585159aa48515cc/Mapping-Levels-of-Palliative-Care-Development-in-198-Countries-The-Situation-in-2017.pdf?origin=publication_detail

 

Derbyshire Alliance for End of Life Care Toolkit

The Toolkit has been designed collaboratively by professionals who work across Derbyshire (the self-titled ‘Derbyshire Alliance for End of Life Care’) to help teams plan and deliver care for people in their last months, weeks and days of life.

https://derbyshire.eolcare.uk/

Ambitions for Palliative and End of Life Care Resources

Many of the resources on this site have been transferred from the NHS IQ and the End of Life Care Facilitators’ Network websites. We are now uploading resources from other organisations.

http://endoflifecareambitions.org.uk/resources/

Late Stage and End-of-Life Care

Depending on the nature of the illness and your loved one’s circumstances, this final stage period may last from a matter of weeks or months to several years. During this time, palliative care measures can help to control pain and other symptoms, such as constipation, nausea, or shortness of breath. Hospice care can also offer emotional and spiritual support to both the patient and their family.

https://www.helpguide.org/articles/end-of-life/late-stage-and-end-of-life-care.htm

Now you can download many of our publications as PDFs, MP3 audio files and eBooks. Keep coming back as we’re adding more resources all the time.

https://be.macmillan.org.uk/be/s-574-audio-pdf-and-ebook-downloads.aspx  

 

Missisauga Halton Palliative Care Toolbox

Palliative care aims to improve a person's quality of life through improved symptom management while addressing psychosocial, emotional and spiritual issues. It is care that is appropriate at all stages of a person's illness. An interdisciplinary care team may include your family physician, non palliative specialist physicians, palliative care physician or nurse practitioner, social workers, dietitians, nurses, spiritual care workers and other health professionals (Cancer Care Ontario, 2013).

This web page is designed with the primary care provider in mind, as a resource in navigating the provision of palliative care in the Missisauga Halton LHIN, with links to best practice tools and local resources. Tools are organized according to the 3-step model of best practice proposed by the Gold Standards Framework (GSF): Identify, Assess, and Plan.

http://www.mhpcn.net/palliative-care-toolbox

This package is a guide for services to support the effective use of the PCOC clinical assessment tools.

PCOC is regarded as a core national palliative care program funded by the Australian Government Department of Health. The PCOC model is also being implemented internationally. 

National benchmarking is also core to the outcomes program. PCOC’s approach to benchmarking helps support services to come together to form a community of practice. PCOC’s benchmarking supports services in identifying what works in clinical practice and sharing these innovations for the benefit of patients and their carers. There are twenty national benchmarks. Each benchmark was established in consultation with the palliative care sector. Download the Guide to National Outcome Measures and Benchmarks (pdf)

https://ahsri.uow.edu.au/pcoc/assessment-package/index.html

 

RPMG - Guidance for the Management of Symptoms in Adults in the Last Days of Life
http://www.professionalpalliativehub.com/sites/default/files/RPMG%20End%20of%20Life%20Guidance%202018_0.pdf

LEAP Additional Resources
The Centre for Education and Research on Aging & Health is located at the Balmoral Street Centre on the Lakehead University campus in Thunder Bay, Ontario.
https://cerah.lakeheadu.ca/leap-additional-resources/

Palliative Care Community

The Palliative Care Program Committee represents the interests of all members of the College of Family Physicians of Canada (CFPC) providing Palliative Care, including those for whom this is part of their broad scope family practice and those with a special interest or focused practice.

https://www.cfpc.ca/PalliatCareCommReferences/

Palliative and End-of-Life Care in Stroke

All patients and families with a stroke that adversely affects daily functioning or will predictably reduce life expectancy or quality of life should have access to and be provided with primary palliative care services appropriate to their needs (Class I; Level of Evidence B).

https://sites.google.com/view/palliativecareinstroke/home

An all-island gateway to palliative care information
The Palliative Hub - Professional is a resource for all those working in the palliative care community
http://www.professionalpalliativehub.com/homepage

Printable Patient Resources
https://www.caresearch.com.au/caresearch/tabid/3666/Default.aspx

Medications and Suggested Doses for Palliative Sedation

• Midazolam 0.5–5 mg bolus IV/SC, then CII/CSI at 0.5–1 mg/h; usual maintenance dose, 20–120 mg/d
• Lorazepam 0.5–2 mg PO, SL, or SC every 1–2 hours or 1–5 mg bolus IV/SC, then CII/CSI at 0.5–1 mg/h; usual maintenance dose, 4–40 mg/d
• Chlorpromazine 10–25 mg PO, IV, or PR every 2–4 hours
• Haloperidol 0.5–5 mg PO or SC every 2–4 hours or 1–5 mg bolus IV/SC, then CII/CSI at 5 mg/d; usual maintenance dose, 5–15 mg/d
• Pentobarbital 60–200 mg PR every 2–4 hours or 2–3 mg/kg bolus IV, then CII at 1 mg/h; titrate upward to maintain sedation
• Phenobarbital 200 mg IV/SC bolus, then CII/CSI at 600 mg/d; usual maintenance dose, 600–1,600 mg/d
• Thiopental 5–7 mg/kg bolus IV, then CII at 20 mg/h; usual maintenance dose, 70–180 mg/h
• Propofol 10 mg/h as CII; may titrate by 10 mg/h every 15–20 minutes; bolus of 20–50 mg may be used for emergency sedation

a Clinicians should consult pharmacy textbooks, pharmacists, and other knowledgeable professionals for further dosing suggestions.
PO = oral; PR = per rectum; SL = sublingual; IV = intravenous; SC = subcutaneous; CII = continuous intravenous infusion; CSI = continuous subcutaneous infusion

https://palliative.stanford.edu/palliative-sedation/medications-of-choice/

THE DYING PROCESS

The dying process

Changes you may notice and what you can do to help

 https://sites.google.com/view/10-tips-for-prescribingeolc/the-dying-process

 

Needs Assessment Guidance

This document provides guidance to health and social care professionals who provide or co-ordinate the care of people with life-limiting conditions. It helps professionals to assess the palliative care needs of patients with life-limiting conditions and to decide when it is appropriate to refer to a specialist palliative care service. 

https://www.hse.ie/eng/about/who/cspd/ncps/palliative-care/resources/needs-assessment-guidance/

PCOC Assessment Forms

The ultimate measure of quality is the outcomes that patients, their families and carers achieve. PCOC is a voluntary program that is improving the quality and outcomes in palliative care in Australia, and internationally.

https://ahsri.uow.edu.au/pcoc/forms/index.html

Understanding Cancer books

Understanding Cancer is a series of more than 60 resources for people with cancer, their families and friends. The series includes easy-to-read information about specific types of cancer, treatments, and emotional and practical issues.

https://www.cancercouncil.com.au/publications/understanding-cancer-book/

ONTARIO PALLIATIVE CARE NETWORK PALLIATIVE CARE TOOLBOX
https://www.ontariopalliativecarenetwork.ca/en/node/31896

Palliative Care Fast Facts and Concepts
Palliative Care Fast Facts and Concepts—originally published by EPERC since 2000. Fast Facts are edited by Sean Marks, MD; Associate Professor of Medicine at the Medical College of Wisconsin.
https://www.mypcnow.org/fast-facts/

Palliative care  

Palliative care is about improving the quality of life of anyone facing a life-threatening condition. It includes physical, emotional and spiritual care.

https://www.nhsinform.scot/care-support-and-rights/palliative-care

By treating pain, other symptoms, and psychological and spiritual distress, by using advanced communication skills to establish goals of care and help match treatments to those individualized goals, and by providing sophisticated care coordination, palliative care provides an added layer of support to patients, their loved ones, and treating clinicians.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671283/

What is the Core Team?
The people who meet regularly to go over progress and make action plans are the core team. Other people may help you with some part of the project and they come and go as needed, but the core team stays through the whole effort. Most teams work best with 5-7 core team members.

Why Limit the Number of Team Members?
Everyone is busy, and QI projects require frequent and regular team meetings. With 5-7 team members, the team will be able to include those responsible for enough of the problem while staying small enough to make decisions rapidly. This size group can usually find time to meet regularly and stay in touch with one another. A project that really requires 12 or more on the core team probably should split up the jobs and coordinate efforts.
http://growthhouse.org/commonsense/index.html

If you think that the patient may need medication to help them manage sleep problems, speak to their GP, district nurse or specialist nurse. They can review any medicines, such as steroids, that might be contributing to sleep problems and make sure that the person’s other symptoms are being managed as well as possible. They may arrange further assessment or prescribe medicines including:

•     short-acting benzodiazepines such as lorazepam or temazepam
•     hypnotics such as zopiclone or zolpidem.

https://www.mariecurie.org.uk/

Understanding Cancer is a series of more than 60 resources for people with cancer, their families and friends. The series includes easy-to-read information about specific types of cancer, treatments, and emotional and practical issues. There are also audio-visual materials that can be downloaded or streamed online.

https://www.cancercouncil.com.au/publications/understanding-cancer-book/

Royal College of Physicians
https://www.rcpjournals.org/search/palliative%20jcode%3Aclinmedicine%20numresults%3A100%20sort%3Arelevance-rank

End‐of‐life care pathways for improving outcomes in caring for the dying
https://www.cochranelibrary.com/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD008006.pub4&doi=10.1002/14651858.CD008006.pub4&type=cdsr&contentLanguage=

 

Advance care planning is an ongoing discussion between a patient and their carers, family and health professionals about the patient’s values, beliefs, treatment and care options.

 

It focuses in particular on the patient’s preferences for their future treatment and care should they no longer be able to make or communicate their decisions at the time they are needed. 

 

End-of-life is the timeframe during which a person lives with, and is impaired by, a life-limiting/fatal condition, even if the prognosis is ambiguous or unknown. 

 

Those approaching end-of-life will be considered likely to die during the next 12 months. 

 

End-of-life care is care needed for people who are likely to die in the next 12 months due to progressive, advanced or incurable illness, frailty or old age. During this period, people may experience rapid changes and fluctuations in their condition and require support from a range of people, including health services, as well as family and carers. 

 

Loss, grief, bereavement and mourning
 

Loss refers to the severing of attachment to someone or something.
 

Grief is the multidimensional responses to loss.
 

Bereavement is the situation of having lost a significant person through their death.
 

Mourning refers to expressions of grief, including social practices.

https://web.archive.org/web/20210605112550/https://ww2.health.wa.gov.au/-/media/Corp/Documents/Health-for/End-of-Life/Education-and-Training-Framework.pdf
 

 

 

Ooookay kan, Bro!

IKA SYAMSUL HUDA MZ