&#9728; &#9728; PALLIATIVE CARE FACTS AND STATS

https://meded.kku.ac.th/medednew/palliative_care/01_Palliative_care-Why_and_how.pdf

☛   Approximately 90 million Americans
are living with serious illness,
and this number is expected to more
than double over the next 25 years
with the aging of the baby boomers.

☛   Approximately 6,000,000 people
in the United States
could benefit from palliative care.

☛   Palliative care is the medical specialty
focused on improving quality of life
for people facing serious illness.

☛   Palliative care provides relief
from the symptoms and stress
of a serious illness.

☛   The goal is to improve quality of life
for both the patient and their family.

☛   Palliative care is provided
by an interdisciplinary team
of palliative care specialists,
including doctors, nurses, social workers
and others who work with
a patient's other doctors
to provide an extra layer of support.

☛   Palliative care is appropriate
at any age and at any stage
in a serious illness,
and it can be provided together
with curative treatment.

☛   According to a 2010 study
reported in the New England Journal of Medicine,
lung cancer patients receiving
early palliative care had less depression,
improved quality of life
and survived 2.7 months longer.

☛   Illnesses most commonly treated
by palliative care are heart disease,
cancer, stroke, diabetes, renal disease,
Parkinson’s and Alzheimer’s disease.

☛   Approximately 68% of Medicare costs
are related to people with four
or more chronic conditions
—the typical palliative care patient.

☛   If palliative care were fully penetrated
into the nation’s hospitals,
total savings could amount
to $6 billion per year.

☛   Palliative care growth in hospitals
has been exponential.
Due largely to the work of CAPC,
the number of teams has increased
by 164% over 12 years.
To date, there are more than 1700 hospitals
with a palliative care team.

☛   Approximately 61% of all hospitals
with more than 50 or more beds have
a palliative care team today.

☛   Where you live matters
when it comes to access
to hospital palliative care.
(See the palliative care national
and state-by-state report card
at capc.org/reportcard).

☛   According to a 2011 poll
conducted by Public Opinion Strategies,
once informed about palliative care:

☛   95% of poll respondents agreed
that it is important that patients
with serious illness and their families
be educated about palliative care.
92% of poll respondents said
they would be likely to consider
palliative care for a loved one
if they had a serious illness.
92% of poll respondents said
it is important that palliative care services
be made available at all hospitals
for patients with serious illness and
their families.

CAPC Center to Advance Palliative Care, 2014
https://web.archive.org/web/20210130125552/https://media.capc.org/filer_public/68/bc/68bc93c7-14ad-4741-9830-8691729618d0/capc_press-kit.pdf

When should palliative be considered?
Palliative Care can be provided at any time, to anyone with advanced illness, regardless of age. It is often difficult to know when the time is right to actually become registered with a palliative care program.

These are some signs that Palliative Care is right for your loved one:

The patient has been diagnosed with a life limiting illness
Pain and suffering have become increasingly difficult
Frequent visit to the Emergency Unit are required
The care giver is physically suffering and feels overwhelmed by responsibility

https://web.archive.org/web/20211030083004/https://d2y1pz2y630308.cloudfront.net/12425/documents/2019/1/Palliative%20Care.pdf

SUPPORTIVE CARE

Palliative care has come to be regarded as part of supportive care
formally introduced by the National Institute for Clinical Excellence (NICE) in 2004.

Supportive care describes all care provided to patients, friends and family
throughout their illness, including the time before diagnosis has been reached,
when patients may be undergoing a number of investigations.

The aim of supportive care is to help the patients and their families
to cope with their condition and treatment.

It helps the patient to maximise the benefits of treatment and
to live as well as possible with the effects of the disease.

(National Council for Palliative Care (NCPC) 2010)
https://web.archive.org/web/20211225202330/https://catalogimages.wiley.com/images/db/pdf/9781118437803.excerpt.pdf

Misconceptions
• Palliative care is hospice
• Cancer patient’s symptoms are always addressed and managed
• Cancer patients don’t want to hear about prognosis and treatment options
• Cancer patients want to die in the hospital or ICU

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

Seventy-five percent of all deaths can be expected;
this is when a person with
an incurable life-limiting disease is

likely to die within
the next year.

Such people benefit from palliative care,
which improves their quality of life
and experience of dying

through early
identification,
assessment
and treatment
of physical,
psychological,
social,
cultural
and spiritual symptoms and needs,
respecting their care preferences,
and supporting their carers and family
in bereavement.

https://web.archive.org/web/20210516082644/https://www.wnswphn.org.au/uploads/documents/ePAF/X8%20-%20A%20mapping%20study%20to%20guide%20a%20palliative%20approach%20to%20care.%20Rural%20and%20Remote%20Health%202019.pdf

Due to new treatments and technology in critical care units, more patients now survive critical illness. However, even with this help, 15-20% of UK critical care patients die in hospital. End-of-life care therefore remains a necessary core skill for intensive care teams.

Such care includes:

• Assessing and managing symptoms e.g. pain, nausea, anxiety, delirium,
• Enabling patients and those close to them to take part in care decisions;
• Understanding legal and ethical processes for withdrawal and withholding treatments
• Minimising distress
• Ensuring patients (and those close to them) do not feel abandoned
• Meeting beliefs and religious needs

https://web.archive.org/web/20210601001101/https://www.ficm.ac.uk/sites/default/files/ficm_care_end_of_life_patient.pdf

PALLIATIVE CARE - THE MODERN CONCEPT
The Medical Journal Of Australia November 27, 1982
https://web.archive.org/web/20210601061352/http://wanterfall.com/Copyright/Palliative_care_The_modern_concept.pdf

Palliative Care
KULIAH MATRIKULASI
MAGISTER TERAPAN KEPERAWATAN POLTEKES
13 September 2021

Download materi:
https://bit.ly/matrikulasi_PC_2021

Palliative care needs are complex
and span physical, emotional, social, and spiritual concerns.
Research on the key concerns for people
toward the end of life indicate that
the most pressing needs relate to:

• pain and symptom management
• preparation for the end of life
• relationships between patients, family members and health care providers
• achieving a sense of completion (Steinhauser et al., 2000)

Such needs will vary by
age,
disease status, and
social and
cultural context.
https://web.archive.org/web/20210520132459/https://www.acn.edu.au/wp-content/uploads/white-paper-end-of-life-care-achieving-quality-palliative-care-for-all.pdf

INDICATORS OF DECLINE

Medicare uses the following indicators
to measure decline.
Patients who suffer from a chronic disease
process and exhibit one or more of these signs
and/or symptoms over time
may benefit from a hospice evaluation.

- Recurrent or intractable infections
- Weight loss not due to reversible causes and/or decreasing anthropomorphic measurements
- Decreasing serum albumin or cholesterol
- Dysphagia leading to aspiration and/or inadequate nutritional intake
- Dyspnea
- Pain requiring increasing doses of analgesia
- Decreasing systolic BP
- Edema and/or ascities
- Pleural effusion
- Weaknessn Decline in Palliative Performance Scale (PPS) to <70% due to disease progression
- Increasing ER visits, hospitalizations, and/or physician visits related to disease progression
- Progressive decline in Functional Assessment Staging (FAST) for dementian Progressive pressure ulcers

https://web.archive.org/web/20170816070125/https://coastalhospice.org/app/uploads/2017/01/ReferralGuidelines.pdf

PALLIATIVE CARE

Palliative care is about maintaining quality of life.
The aim of palliative care is neither to hasten nor postpone death.
Rather, the focus is on living as well as possible, for as long as possible.

Palliative care may include:

Relief of pain and other symptoms e.g. vomiting, shortness of breath
Medication management
Food and nutrition advice and support
Care and education to support better mobility and sleeping
Resources such as equipment needed to aid care at home
Assistance for families to come together to talk about sensitive issues
Links to other services such as home help and financial support
Support for people to meet cultural obligations
Support for emotional, social and spiritual concerns
Counselling and grief support for the person with the illness and their family and carers
Referrals to respite care services
Bereavement care to the family and carers once the person has died.

https://morethanyouthink.org.au/what-is-palliative-care/
https://web.archive.org/web/20210530221040/https://morethanyouthink.org.au/what-is-palliative-care/

The key standards for this
Palliative and Supportive Care plan are:

1. The patient has an initial assessment
of performance and symptom status
when it is recognised that
they have palliative care needs
or are at risk of dying.

2. The patient’s care plan has been reviewed
by a senior clinician and reflects
their palliative and supportive needs.

3. A regular review of the patient’s performance status,
symptoms and care needs is undertaken,
recorded and care amended as needed.

4. Potentially reversible causes of decline
are identified and treated,
if appropriate.

5. Irreversible causes of decline
are clearly recorded and appropriate comfort measures
put in place.

These five standards can then be used to plan
and review patient care.

https://web.archive.org/web/20210520055629/https://www.nhsgrampian.org/globalassets/foidocument/foi-public-documents1---all-documents/nhsg-palliative-and-supportive-care-plan.pdf

Misconceptions

• Palliative care is hospice
• Cancer patient’s symptoms are always addressed and managed
• Cancer patients don’t want to hear about prognosis and treatment options
• Cancer patients want to die in the hospital or ICU
• Patients are only appropriate for Palliative Care when all treatment options have been exhausted…….
• “I guess we can now get “palliative” involved
• Palliative care conversation will take away hope

https://web.archive.org/web/20210522081456/https://www.unitypoint.org/desmoines/filesimages/Stoddard%20Experience/Nursing%20Conference%20Handouts/New%20Palliative%20Care%20%20Oncology%20Integration%202017%20%282%29.pdf

According to Taber’s Cyclopedic Medical Dictionary,
palliative care is defined as
“serving to relieve or alleviate, without curing.”

Palliative care is further refined at the NIH as the following:

not time-limited to end-of-life
optimized through early initiation and comprehensive implementation throughout the disease trajectory
parallels aggressive research and treatment modalities
a combination of active and compassionate therapies that is primarily focused on the physical, psychological, social, and spiritual “suffering” of the patient, family, and caregiver
not limited to pain management
comprehensive management of any symptom which affects the quality of life

https://web.archive.org/web/20210401113255/https://clinicalcenter.nih.gov/palliativecare/pdf/establishing_palliative_care_program.pdf

Only a small proportion of patients
need to be seen by a palliative care medical specialist.
Most can be managed by their general practitioner
and their existing specialists –
for example oncologist, general physicians and geriatricians.

Those patients for whom advice from, or review by,
a Palliative Medicine Physician
may be useful include:

refractory symptom management including pain control, nausea/vomiting, constipation, delirium etc
assistance with end of life decision making (i.e. withdrawal of treatment, artificial hydration etc)
advance care planning
management /referral of patients/carers with profound existential distress, grief or bereavement issues