☀ ☀ INFOGRAPHIC PALLIATIVE CARE


INFOGRAPHIC PALLIATIVE CARE
 
WHAT IS PALLIATIVE CARE ?

It improves quality
of life.

It can be given in
homes, health
centres, hospitals
and hospices.

It is care for patients with
life-threatening illnesses
& their families.

It benefits health systems
by reducing unnecessary
hospital admissions.

It relieves physical,
psychosocial &
spiritual suffering.

It can be done by many types
of health professionals &
volunteers.


https://web.archive.org/web/20200824024241/https://www.who.int/ncds/management/palliative-care/Infographic_palliative_care_EN_final.pdf
 

Palliative care is based on a model developed in response
to the needs of cancer patients by the hospice movement in the UK.
Such treatment, while not curative, nevertheless prolongs life
for considerable periods of time and restores quality of life.
https://www.who.int/3by5/en/palliativecare_en.pdf



CAREGIVERS

Support for caregivers
is an essential part of palliative care,
whether they be family members
or professional carers.

For professional carers,
an integral part
of providing palliative care
is to work with families and friends
to ensure effective communication.

https://web.archive.org/web/20200816120954/https://www.who.int/3by5/en/palliativecare_en.pdf

ASPECTS OF CARE
 
https://web.archive.org/web/20210915021658/https://www.unitypoint.org/desmoines/filesimages/Stoddard%20Experience/Nursing%20Conference%20Handouts/New%20Palliative%20Care%20%20Oncology%20Integration%202017%20%282%29.pdf


WHEN IS PALLIATIVE CARE USED IN CANCER CARE?
Palliative care is given throughout
a patient’s experience with cancer.
It should begin at diagnosis
and continue through treatment,
follow-up care,
and the end of life.

WHO GIVES PALLIATIVE CARE?
Although any medical professional
may provide palliative care
by addressing the side effects
and  emotional  issues  of  cancer,  
some  have  a  particular  focus  
on  this  type  of  care.  

A palliative  care  specialist  is  
a health  professional  who  specializes  
in  treating  the  symptoms,
side  effects,  
and  emotional  problems  
experienced  by  patients.  
The  goal  is  to  maintain  
the best possible quality of life.

Often, palliative care specialists work
as part of a multidisciplinary team
to coordinate care.
This palliative  care  team  may  
consist  of doctors,
nurses,  
registered  dieticians,  
pharmacists,
and  social  workers.  
Many  teams  include  psychologists  
or  a  hospital  chaplain  as  well.

Palliative care specialists
may also make recommendations
to primary care physicians
about the  management  of  pain  
and  other  symptoms.  

People  do  not  give  up  
their  primary  care physician
to receive palliative care.

https://web.archive.org/web/20210516114044/https://www.cancercareontario.ca/sites/ccocancercare/files/assets/ACCUPalliativeCare.pdf





YAPALINDO

End of life: a guide A booklet for people in the final stages of life, and their carers
http://be.macmillan.org.uk/Downloads/CancerInformation/EndOfLife/MAC12149EndOfLife-E3.pdf

End of life care
How we treat people in their final months shows the value that we, as a society, place on life – and at Macmillan we believe that there is such a thing as a ‘good’ death.

The clinical care domains for end of life include:
• Advance care planning
• Recognise end of life
• Assess palliative care needs
• Provide palliative care
• Work together
• Respond to deterioration
• Manage dying
• Bereavement

Here we discuss the common medicines used in syringe drivers to treat these symptoms. All medicines can cause side effects, so it’s a good idea to check what to expect with your doctor or nurse before taking them. A specialist doctor or nurse may also suggest other drugs to control difficult symptoms.

Drinks are measured in levels 0-4. If you’re unable to swallow a thinner (lower level) drink, your healthcare team might suggest having a thicker (higher level) drink.

Not everyone approaching the end of life has pain, but if you do, your doctor or nurse will assess the pain and decide on a suitable drug and the correct dose to manage it.

PEDOMAN NASIONAL PALIATIF KANKER

 There are currently three programmes of research: each focused on people affected by cancer, other life limiting illnesses, and those requiring end of life care:
https://www.southampton.ac.uk/chp/research/endoflife.page


 Management of Lymphoedema in Palliative Care
Lymphoedema occurs due to the inability of the lymphatic system to maintain normal tissue homeostasis. This results in an accumulation of protein-rich fluid in the subcutaneous tissues.
Lymphoedema is one form of chronic oedema.
In patients with cancer, lymphoedema is often secondary to the underlying cancer or previous cancer treatment.

Where available, patients should be referred to specialist lymphoedema clinics
The core treatment elements are:
  • • Skin care – keep skin intact, clean and well hydrated with non-perfumed emollient (e.g, Diprobase®, Doublebase® or Zerobase®)
  • • Compression/support stockings
  • • Movement and exercise
  • • Simple lymph drainage, self-massage techniques.
  • • Avoid affected limb for any medical procedure where possible, e.g injection, venepuncture, blood pressure measurement
https://leedspalliativecare.org.uk/wp-content/uploads/2019/09/A-Guide-to-Symptom-Management-in-Palliative-Care-Yorkshire-and-Humber-End-of-Life-Care-Group.pdf
The concept of “total pain” or “total suffering” indicates that there are many factors which contribute to the experience of pain and other physical symptoms and each patient must be treated with the knowledge that physical symptoms cannot be treated in isolation. Whatever symptom a patient is experiencing it is important to look at it in the context of the above diagram which describes the concept of total suffering.
http://mobcdhb.palliativecare.org.nz/Total%20Suffering.pdf

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.

Primary care professionals play a huge role in the care of people affected by cancer. We have developed an exciting new cancer resource for whole practice teams – the Macmillan Cancer Quality Toolkit for Primary Care (Wales). It is designed to support practices to review cancer services and make changes to help deliver improved person-centred care to the increasing number of people affected by cancer in Wales.
http://www.primarycareone.wales.nhs.uk/macmillan-cancer-quality-toolkit

Poor communication, planning, pain management and co-ordination lead to tragic and avoidable suffering.
Anticipatory prescribing and ‘just in case’ boxes are an important part of end-of-life care. Anticipatory prescribing enables prompt symptom relief at whatever time the patient develops distressing symptoms.
  1. 1. Ensures there is a supply of drugs in the patient’s home
  2. 2. Ensure they have the apparatus needed to administer them
  3. 3. Ensures both are available to an attending clinician for use where appropriate
  4. 4. These drugs belong to the patient, and have the same legal status as other prescribed controlled drugs.
https://www.bma.org.uk/advice-and-support/gp-practices/prescribing/anticipatory-prescribing-for-end-of-life-care

Signs of pain include:
  • Noisy breathing – labored, harsh, or rapid breaths
  • Making pained sounds – including groaning, moaning, or expressing hurt
  • Facial expressions – looking sad, tense, or frightened; frowning or crying
  • Body language – tension, clenched fists, knees pulled up, inflexibility, restlessness, or looking like they’re trying to get away from the hurt area
  • Body movement – changing positions to get comfortable but can’t
https://www.cancer.org/treatment/end-of-life-care/nearing-the-end-of-life/physical-symptoms.html

Assessment forms can ensure that:
  • Assessments are routinely completed as a suite at each assessment occasion.
  • Assessment scores are documented or recorded at point of care.
These forms are for use with the PCOC Version 3 dataset. The PCOC Assessment Form is used in all palliative care settings.
https://ahsri.uow.edu.au/pcoc/forms/index.html

Palliative care does not end with the patients’ death, but includes supporting the family members in dealing with the loss. Bereavement support can help bereaved individuals adapt to their loss and has become an established part of palliative care. https://bit.ly/3bwdHPP

 

Prescribing Anticipatory Drugs

‘Anticipatory’ drugs in a palliative setting are those drugs that are prescribed for use on an ‘as required’ basis to manage common symptoms that can occur at the end of life. In most cases these drugs will be prescribed as a subcutaneous injection and will usually include four key drugs: an opioid (for management of pain or breathlessness), an antiemetic, an antisecretory drug (for respiratory secretions) and a sedative.

Readily available anticipatory drugs can prevent inappropriate readmissions to hospital. It is especially important to ensure that drugs are available over weekends and bank holidays.
https://web.archive.org/web/20200720092733/https://www.northkirkleesccg.nhs.uk/wp-content/uploads/2013/07/Guidance-on-Prescribing-Anticipatory-Drugs-and-Syringe-Drivers-in-the-Community.pdf

 

Australia-modified Karnofsky Performance Status (AKPS)
The AKPS is a useful modification of the KPS that is more appropriate for clinical settings that include multiple venues of care such as palliative care.
https://bmcpalliatcare.biomedcentral.com/articles/10.1186/1472-684X-4-7

A conceptual framework toward understanding “actively dying,” “end of life,” “terminally ill,” “terminal care,” and “transition of care.” Based on our systematic review, end of life, terminally ill, and terminal care period are synonymous and apply to patients with progressive disease with months or less of expected survival. Actively dying is related to patients with days of survival, and transition of care is related to changes in the place of care, level of care, and goals of care.
https://www.jpsmjournal.com/article/S0885-3924(13)00243-1/fulltext#sec3.3

If your patient is approaching the end of life at home, you may wish to prescribe anticipatory medication to be available in the patient’s home. You will also need to prescribe the medications on a ‘prescription chart’ to allow for administration at home. Syringe drivers can also be prescribed on these cards. Download a reminder card for health care professionals about anticipatory medications Download our patient information leaflet about anticipatory medications. Treatment algorithms for medication use in the dying phase can be found here:
https://bit.ly/2LpTIYw

Palliative and End of Life Care Toolkit

There is a lack of any strong evidence, therefore decisions to initiate subcutaneous (SC) hydration rests with the multidisciplinary team in discussion with the patient and family, and will vary from patient to patient depending on the estimated burden to benefit balance.

TEN STEPS TO BETTER PROGNOSTICATION

Anticipatory end of life care medication for the symptoms of terminal restlessness, pain and excessive secretions in frail older people in care homes. End of Life Journal Vol. 3, No. 3, pages 1-6)

Hypodermoclysis, the subcutaneous infusion of fluids, is a useful and easy hydration technique suitable for mildly to moderately dehydrated adult patients, especially the elderly. The method is considered safe and does not pose any serious complications.

Clinical Practice Guidelines for Quality Palliative Care, 4th edition, create a blueprint for excellence by establishing a comprehensive foundation for gold-standard palliative care for all people living with serious illness, regardless of their diagnosis, prognosis, age or setting.

Palliative care focuses on the person and their family, and on enhancing their quality of life throughout their illness, not just at the end of life. The initiation of palliative care should not be delayed for people with a progressive, life-limiting illness if they have physical, psychological, social, or spiritual needs during treatment.

PANG Clinical Guidelines book.pallcare.info provides alternative access to the PANG guidelines 2016 (version 4). The screen layout is designed for a desktop PC, and will not work well on a small screen e.g. mobile phone. No site registration is required.

Berdoa Menutup Sedih Tanpa Biaya

Pediatric Hospice and Palliative Medicine (PHPM) is both a philosophy and an organized method for delivering competent, compassionate, and consistent care to children with chronic, complex and/or life-threatening conditions, as well as to their families.

PALLIATIVE CARE CARE FOR ADULTS WITH A PROGRESSIVE, LIFE-LIMITING ILLNESS

Demonstrate the value of your pediatric palliative care service to program stakeholders.

Morphine Sulfate 10mg/ml Injection BP
  • Morphine Sulfate may be given by the subcutaneous, intramuscular or intravenous route. The subcutaneous route is not suitable for oedematous patients. The dosage should be based on the severity of the pain and the response and tolerance of the individual patient. The epidural or intrathecal routes must not be used as the product contains a preservative.
  • Prior to starting treatment with opioids, a discussion should be held with patients to put in place a strategy for ending treatment with morphine sulphate in order to minimise the risk of addiction and drug withdrawal syndrome
 https://www.medicines.org.uk/emc/product/2244/smpc

Palliative Sedation: Myth vs. Fact
Patients with poorly controlled pain, shortness of breath, and agitation actually die sooner because of the stress caused by this suffering. Studies clearly demonstrate that palliative sedation does not hasten death.
https://www.capc.org/about/press-media/press-releases/2010-1-6/palliative-sedation-myth-vs-fact/

The more common side effects that can occur with dexamethasone oral tablets include:

  • nausea
  • vomiting
  • stomach upset
  • swelling (edema)
  • headache
  • dizziness
  • mood changes, such as depression, mood swings, or personality changes
  • trouble falling asleep
  • anxiety
  • low potassium levels (causing symptoms such as tiredness)
  • high blood glucose
  • high blood pressure
If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

https://www.healthline.com/health/dexamethasone-oral-tablet#side-effects

BMC Palliative Care

http://www.biomedcentral.com/bmcpalliatcare/

 

BMJ Supportive Palliative Care

http://spcare.bmj.com/

 

Current Opinion in Supportive and Palliative Care

http://journals.lww.com/co-supportiveandpalliativecare/pages/currenttoc.aspx

 

Family Practice Palliative Care

http://www.fppc.com.tr/en/

 

HIV/AIDS - Research and Palliative Care

http://www.dovepress.com/hivaids---research-and-palliative-care-journal

 

Indian Journal of Palliative Care

http://www.jpalliativecare.com/currentissue.asp

 

Journal of Geriatrics and Palliative Care

http://www.avensonline.org/medical/journal-of-geriatrics-and-palliative-care/home-10

 

Journal of Pain Palliative Care Pharmacotherapy

http://www.tandfonline.com/loi/ippc20

 

Journal of Social Work in End-of-Life Palliative Care

http://www.tandfonline.com/loi/wswe/

 

Palliative Supportive Care

https://www.cambridge.org/core/journals/palliative-&-supportive-care

 

Palliative Care Social Practice

https://journals.sagepub.com/home/pcr

 

Palliative Care: Research and Treatment

http://journals.sagepub.com/home/pcr

 

Progress in Palliative Care

http://www.tandfonline.com/loi/yppc20

 

WHAT IS PALLIATIVE CARE ?

 

 

 

Pediatric Palliative Care Approach to

Pain & Symptom Management

2020

https://web.archive.org/web/20200910094138/https://pinkbook.dfci.org/assets/docs/blueBook.pdf

 

Show an interest in the patient’s symptoms.

 

Many patients with advanced cancer believe

that suffering is an inevitable part

of the disease or of its treatment.

 

Ask patients about their symptoms

in a positive and detailed fashion,

starting with open-ended questions

and following up with specific questions.

 

Patients may underreport their symptoms

or may not mention them

if not asked directly.

 

https://www.ccjm.org/content/78/1/25





 

 

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