Many people think
that palliative care
is end of life care,
but it is more than that.
Palliative care may
be offered at any time
during your disease journey,
depending on your symptom burden,
and is complementary to treatment.
It may be in conjunction
with active treatment
or when active treatment
is no longer appropriate.
You will be living
with your brain tumour
and may do so for a long time.
The focus here
is on managing symptoms
so that you can lead
a good quality of life.
Prevention and relief
of suffering is done
through early identification,
assessment and treatment
of pain and other problems,
which include
physical, psychosocial and spiritual.
https://web.archive.org/web/20210121052725/https://c6q4s2z2.rocketcdn.me/wp-content/uploads/2019/05/7-brainstrust-pg2019-palliative-care-8pp.pdf
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
An approach to care that does not attempt to lengthen or shorten the client's life. It acknowledges death is drawing near, although this may be many months or even years away. The approach also recognises that a range of symptoms may need to be addressed to improve overall comfort during life and around the time of death. (DoHA 2006)
https://www.pallcaretraining.com.au/mod/page/view.php?id=198
APPROACHING THE END OF LIFE
- DIE WITHIN THE NEXT 12 MONTHS -
https://pharmacopallcare.blogspot.com/2020/09/approaching-end-of-life-die-within-next.html
THE HEALTHCARE COSTS ASSOCIATED WITH DYING ARE HIGH
The healthcare costs
associated with dying are high,
particularly in the last year of life
when many people spend time in hospital.
Compared with home-based care,
the cost of caring
for a chronically
or terminally ill person
in hospital is
significantly higher.
There is some evidence
that the provision
of high-quality palliative care
may lower health costs
by reducing hospitalisation
at the end of life.
https://web.archive.org/web/20200414172638/https://ahha.asn.au/sites/default/files/docs/policy-issue/ahha_position_statement_-_palliative_care_0.pdf
The healthcare costs
associated with dying are high,
particularly in the last year of life
when many people spend time in hospital.
Compared with home-based care,
the cost of caring
for a chronically
or terminally ill person
in hospital is
significantly higher.
There is some evidence
that the provision
of high-quality palliative care
may lower health costs
by reducing hospitalisation
at the end of life.
https://web.archive.org/web/20200414172638/https://ahha.asn.au/sites/default/files/docs/policy-issue/ahha_position_statement_-_palliative_care_0.pdf
Some people have more complex physical, psychological, social or spiritual problems.
The severity and/or intractable nature of these complex palliative care
problems may exceed the resources of the primary treating team and may
require referral to the specialist palliative care service.
Advance Care Directives
Since 1 July 2014 the Advance Care Directives Act 2013 (SA) has been in operation. This allows a person to:
- set out values and wishes to guide decisions about their future healthcare and other personal matters
- set out what, if any, particular healthcare they refuse and in what circumstances and
- appoint one or more substitute decision-makers.
FAMILY CONFERENCE IN PALLIATIVE CARE
ANTECEDENTS
• Decision-making process
• Definition of a care plan
• Intrafamilial conflicts
• Doubts (advantages and disadvantages of therapy)
• Clarification on goals
• Anguish
• Perspectives vis-à-vis illness and death
• A Worsening of the clinical picture
• Proximity of death
• Difficulty in communication
• Need to support the family
ATRIBUTES
• Working instrument
• Integration strategy
• Method of communication
• Family intervention
• Information sharing
• Transmission of information
• Discussion forum (doubts, prognosis and care preferences)
• Family meeting to establish care plans
• Demonstration of appreciation and respect for the family
CONSEQUENTS
• Related to the patient, family and team: effective communication; establish a consensual plan of action; integrate team, patient and family Patient-related: better quality of care; promote active listening
• Family-related: exposing and clarifying doubts reassuring the; greater confidence in the team
• Related to the team: identification of needs; know the clinical history; to know personality traits and care preferences; support to hospital administration
- Active opioid metabolites can accumulate in patients who are frail, debilitated or who have significant renal impairment. This can lead to opioid toxicity, characterised by myoclonic jerks, excessive sedation or confusion, restlessness and hallucinations. Hyperalgesia (increased sensitivity to pain) can also be a feature of opioids toxicity. Patients should be reviewed for features of toxicity of doses are being increased rapidly or to high levels. Switching to another opioid should be considered if opioid toxicity is unable to be managed with appropriate dose adjustment.
- The central nervous system effects of morphine may also be amplified when it is taken in combination with other centrally acting depressants, e.g. benzodiazepines, phenothiazines, tricyclic antidepressants or alcohol. Long-acting morphine may have a faster onset of action when taken with metoclopramide.
EARLY PALLIATIVE CARE COST
https://pharmacopallcare.blogspot.com/2020/09/early-palliative-care-cost-ika-syamsul.html
==========================
- Acetaminophen/paracetamol
- Amitriptyline
- Atropine
- Bisacodyl
- Carbamazepine
- Carbocisteine
- Chlorpromazine
- Citalopram
- Clonazepam
- Codeine
- Desipramine
- Dexamethasone
- Dextromethorpan
- Diazepam
- Diclofenac
- Dimenhydrinate
- Diphenhydramine
- Docusate
- Fentanyl transdermal patch
- Gabapentin
- Glycopyrronium/glycopyrrolate
- Haloperidol
- Hyoscine butyl bromide
- Hyoscine hydrobromide
- Ibuprofen
- Imipramine
- Levomepromazine (Methotrimeprazine)
- Loperamide
- Lorazepam
- Megestrol Acetate
- Methadone
- Metoclopramide
- Midazolam
- Morphine
- Naproxen
- Octreotide
- Olanzapine
- Ondansetron
- Oxycodone
- Phenytoin
- Phenobarbital
- Prochlorperazine
- Risperidone
- Senokot
- Tramadol
- Tranexamic Acid
- Trazodone
Olanzapine http://inctr-palliative-care-handbook.wikidot.com/olanzapine
Furosemide Used in Palliative Care
https://bit.ly/FurosemidePC
- natural opiates, alkaloids contained in the resin of the opium poppy including morphine, codeine and thebaine, but not papaverine and noscapine which have a different mechanism of action;
- semi-synthetic opiates, created from the natural opioids, such as hydromorphone, hydrocodone, oxycodone, oxymorphone, desomorphine, diacetylmorphine (heroin), nicomorphine, dipropanoylmorphine, benzylmorphine and ethylmorphine;
- fully synthetic opioids, such as fentanyl, pethidine, methadone, tramadol and propoxyphene;
- endogenous opioid peptides, produced naturally in the body, such as endorphins, enkephalins, dynorphins, and endomorphins.
Opioids
When to Use:
- Indicated for moderate to severe pain as a single agent or combined with acetaminophen or NSAIDs
- Effective across all 3 pain types (somatic, visceral, and neuropathic)
- Mainstay for treatment of moderate to severe cancer pain
- Oral, liquid, transbuccal, transdermal, rectal, subcutaneous, intravenous formulations
- Does not affect platelets, renal function, liver function, gastric mucosa
- Long-term use of opioids in persistent non-cancer pain without underlying serious illness (e.g. fibromyalgia, chronic low back pain) should only be considered under the supervision of a pain specialist
- Drug choice and dosing adjustments are necessary in patients with underlying organ dysfunction (kidney, liver)
- Side effects are manageable for most patients (constipation, nausea, sedation)
- Should be tapered when discontinued
The patient’s condition should be continually monitored in order to assess the patient’s needs and to give support to the relatives/carers. Clinical experience has shown that in around 3% of cases, the patient’s condition can improve and the patient is no longer deemed to be in the dying phase. A full reassessment of the patient is then undertaken and an alternative management plan is put into place. The patient’s [sic] whose care is supported by the LCP must be assessed closely by the doctors and nurses at the bedside. LCP Version 12 also includes a formal process for reviewing decision making by the multidisciplinary team at least every 3 days over and above the ongoing assessments of the patient’s condition.
http://blog.practicalethics.ox.ac.uk/2012/11/the-liverpool-care-pathway-in-the-news-even-by-the-mails-standards-this-is-low/
This report highlights the fact that too many people are dying without dignity and more can be done to improve the experience of care in the last year and months of life for approximately 355,000 people in England.
https://www.ombudsman.org.uk/publications/dying-without-dignity-0
For example, the pathway recommends that in some circumstances doctors withdraw treatment, food and water from sedated patients in their final days. But Baroness Neuberger said that these guidelines had been misinterpreted to the extent that some patients’ families were even shouted at by nurses for giving them water.
https://www.channel4.com/news/death-dying-care-end-of-life-liverpool-care-pathway
Doctors hostile to the pathway say it is impossible to predict accurately when patients may die, that death on the pathway becomes a ‘self-fulfilling prophecy’, and that the method is used to get rid of difficult patients and to free hospital beds.
http://liverpool-care-pathway-a-national-sc.blogspot.com/2012/10/liverpool-care-pathway-justice-and.html
Commonly medications are prescribed to alleviate symptoms at th end of life often given by a syringe driver.
- Pain ,codeine, Paracetamol, morphine.
- Nausea , cyclizine, ondansetron
- Resp secretions hyoscine
- Anxiety midazolam .
Fluids are not withheld at the end of life . Mouth toilet is given to moisten the mouth
https://rickolddoc.wordpress.com/2014/03/10/the-liverpool-care-pathway/
- "A dying loved one may become delirious, which also can be a frightening experience for everyone involved. Delirium occurs in many of those who are near the end of life. It may have a single cause, or it may result from a combination of several factors such as medicines or changes in the body's metabolism.
- Symptoms of delirium include agitation, hallucinations, and consciousness that comes and goes. These symptoms can usually be managed with medicines."
Hypodermoclysis Guidelines in Palliative Care
https://bit.ly/HypodermoclysisPC
End of life symptoms are generally well controlled
by use of nine commonly used medications:
- morphine sulphate/tartrate
- hydromorphone
- haloperidol
- midazolam
- metoclopramide
- hyoscine hydrobromide
- clonazepam
- hyoscine butylbromide
- fentanyl
Medications contraindicated for use via subcutaneous infusion
due to severe localised reactions:
- prochlorperazine
- diazepam
- chlorpromazine
Medications linked to abscess formation
when used in subcutaneous infusions:
- pethidine hydrochloride
- prochlorperazine
- chlorpromazine
Ookay kan, Bro!
IKA SYAMSUL HUDA MZ
