https://www.caresearch.com.au/caresearch/tabid/99/Default.aspx
3-STEP BEST PRACTICE MODEL
The palliative care tools
are organized according to the 3-step model
of best practice proposed
by the Gold Standards Framework
used in the United Kingdom.
https://www.ontariopalliativecarenetwork.ca/en/node/31896
PALLIATIVE CARE
Palliative care is a crucial part of integrated, people-centred health services.
Relieving serious health-related suffering,
be it physical, psychological, social, or spiritual,
is a global ethical responsibility.
Thus, whether the cause of suffering
is cardiovascular disease,
cancer,
major organ failure,
drug-resistant tuberculosis,
severe burns,
end-stage chronic illness,
acute trauma,
extreme birth prematurity
or extreme frailty of old age,
palliative care may be needed
and has to be available
at all levels of care.
https://www.who.int/health-topics/palliative-care
Palliative sedation refers to the lowing of patient consciousness using medications for the purpose of limiting patient awareness of suffering that is intractable and intolerable.
https://www.prnewswire.com/
Since the goal is symptom relief (and not unconsciousness per se), sedation should be titrated to reduce consciousness to the minimum level necessary to render symptoms tolerable. For most patients this will mean less than total unconsciousness, allowing the patient to rest comfortably, but to be aroused.https://www.prnewswire.com/
Contrast this with the intentional misdefinition of palliative sedation two pro assisted suicide legislators tried to foist on California (AB 2747), under the influence of Compassion and Choices, which would have mutated palliative sedation into terminal sedation via induced coma and dehydration:442 (d) “Palliative sedation” means the use of sedative medications to relieve extreme suffering by making the patient unaware and unconscious, while artificial food and hydration are withheld, during the progression of the disease leading to the death of the patient.
https://www.firstthings.com/
The medical profession should be up in arms.https://www.firstthings.com/
The RADboud indicators for PAlliative Care needs (RADPAC)
Congestive heart failure
- The patient has severe limitations, experiences symptoms even while at rest; mostly bedbound patients (NYHAa IV)
- There are frequent hospital admissions (>3 per year)
- The patient has frequent exacerbations of severe heart failure (>3 per year)
- The patient is moderately disabled; dependent; requires considerable assistance and frequent care (Karnofsky score ≤ 50%)
- The patient’s weight increases and fails to respond to increased dose of diuretics
- A general deterioration of the clinical situation (oedema, orthopnoea, nycturia, dyspnoea)
- The patient mentions ‘end of life approaching’
Chronic obstructive pulmonary disease
- The patient is moderately disabled; dependent; requires considerable assistance and frequent care (Karnofsky score ≤50%)
- The patient has substantial weight loss (±10% loss of body weight in 6 months)
- The presence of congestive heart failure
- The patient has orthopnoea
- The patient mentions ‘end of life approaching’
- There are objective signs of serious dyspnoea (shortness of breath, dyspnoea with speaking, use of respiratory assistant muscles and orthopnoea)
Cancer
- Patient has a primary tumour with a poor prognosis
- Patient is moderately disabled; dependent; requires considerable assistance and frequent care (Karnofsky score ≤50%)
- There is a progressive decline in physical functioning
- The patient is progressively bedridden
- The patient has a diminished food intake
- The presence of progressive weight loss
- The presence of the anorexia–cachexia syndrome (lack of appetite, general weakness, emaciating, muscular atrophy)
- The patient has a diminished ‘drive to live’
https://bjgp.org/content/62/602/e625
DEPRESSION IN PALLIATIVE CARE
https://pharmacopallcare.blogspot.com/2020/09/depression-in-palliative-care-ika.html
Psychological support services assess and help patients with psychological problems of all types and levels of severity, including:
- • anxiety, including adjustment disorders, generalised anxiety states, phobias and panic attacks
- • depression, ranging from adjustment disorders to severe clinical depression
- • problems with personal relationships, including communication with health and social care professionals
- • psychosexual difficulties (such as erectile dysfunction and loss of libido)
- • alcohol and drug-related problems
- • personality disorder
- • deliberate self-harm
- • psychotic illness
- • organic brain syndromes.
A range of psychological interventions can be offered by both the statutory and voluntary sectors. Health and social care professionals offering day-to-day care provide much general psychological support to patients and carers and play a key role in psychological assessment and prevention and amelioration of distress. More specialised services include counselling, clinical and health psychology, liaison psychiatry and social work. These may be available as an integral part of local cancer services or may be part of generic mental health services, primary care services or hospice care. They can be located in GP practices, hospitals or hospices. The voluntary sector provides additional services, including telephone helplines and self-help and support groups.
https://www.nice.org.uk/guidance/csg4/resources/improving-supportive-and-palliative-care-for-adults-with-cancer-pdf-773375005
Consider a trial of medicine to treat noisy respiratory secretions if they are causing distress to the dying person or their carers and conservative measures have not been successful.
Consider the risks and benefits of the use of medications and tailor treatment to the dying person's individual needs or circumstances, using one of the following (off label indication) drugs:
- Atropine
- Glycopyrronium bromide
- Hyoscine butylbromide
- Hyoscine hydrobromide
https://cks.nice.org.uk/palliative-care-secretions#!scenario:1
HOW TO USE THE GSF PIG IN YOUR PRACTICE
Aim of PIG - to support earlier identification of patients nearing the end of their life.The GSF Proactive Identification Guidance, previously known as the Prognostic Indicator Guidance, is a practical guide for clinicians enabling earlier recognition of decline for patients considered to be in their final year/s of life. It is a key tool used within the Gold Standards Framework (GSF) Quality Improvements Training Programmes to support earlier identification of patients, enabling better assessment of their needs and planning care in line with their needs and wishes.
https://sites.google.com/view/howtousethegsf-pig/home
We have designed these initiatives and programs to help you access and receive the best palliative care possible.
https://www.health.gov.au/health-topics/palliative-care/about-palliative-care/what-were-doing-about-palliative-care
https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/treatment-and-care-towards-the-end-of-life
WA Cancer and Palliative Care Network
https://ww2.health.wa.gov.au/Articles/U_Z/WA-Cancer-and-Palliative-Care-Network
The
health care that people receive in the last years, months and weeks of
their lives can help to minimise the distress and grief associated with
death and dying for the individual, and for their family, friends and
carers.
https://www.safetyandquality.gov.au/our-work/end-life-careTrust your intuition
- Ask yourself, “Would I be surprised if this person were to die in the next 12 months?” This simple question is accurate seven times out of ten.
- If not, talk to them and consider registration.
- If it would be a surprise to you if they were to live longer than 6-12 months, they are a high priority for talking and planning.
This free online training is designed for the Australian health context, and is available to participants by simply creating an account and logging in.
END-OF-LIFE PROGNOSTICATION
https://pharmacopallcare.blogspot.com/2020/09/end-of-life-prognostication-ika-syamsul.html
TOP 10 THINGS PALLIATIVE CARE CLINICIANS WISHED EVERYONE KNEW ABOUT PALLIATIVE CARE
- Palliative care can help address the multifaceted aspects of care for patients facing a serious illness
- Palliative care is appropriate at any stage of serious illness
- Early integration of palliative care is becoming the new standard of care for patients with advanced cancer
- Moving beyond cancer: palliative care can be beneficial for many chronic diseases
- Palliative care teams manage total pain
- Patients with a serious illness have many symptoms that palliative care teams can help address
- Palliative care can help address the emotional impact of serious illness on patients and their families
- Palliative care teams assist in complex communication interactions
- Addressing the barriers to palliative care involvement: patients’ hopes and values equate to more than a cure
- Palliative care enhances health care value
Source: Jacob J. Strand, MD; Mihir M. Kamdar, MD; and Elise C. Carey, MD
The common Palliative Performance Score (PPS), for example, evaluates activity levels, ambulation, and mental status — and uses a chart to assign a PPS. The PPS paints a picture of the patient and provides an indicator of how he/she is doing compared to an otherwise well, functioning member of the population at that same age.
In addition to having an assigned PPS, dementia patients are scored in seven categories of increasing debility through a Functional Assessment Staging Test (FAST), which helps confirm that diagnosis.Other diseases have their own specific tests.
https://www.crossroadshospice.com/
Here are some signs that someone is actively dying.
- Your loved one may not want food or drink. There may only be a need for enough liquid to keep the mouth from becoming dry. Do not force food, liquids, or medications.
- Your loved one may sleep a lot more and be in an unresponsive state without the ability to be aroused (coma/semi-coma). This is very natural and it’s important to let your loved one sleep. At this point, it’s important for you to be with them rather than do for them.
- As the oxygen supply to the brain decreases, they may experience severe agitation or hallucinations that are inconsistent with their normal manner or personality, such as pulling on bed linens or clothing. You can talk to them in a calm voice and reassure your loved one that you are there. You can play calm music or give them a back rub.
- Breathing may become irregular with periods of no breathing lasting for 20 to 30 seconds. Raising the head of your loved one’s bed will make breathing easier for them.
- Your loved one may pass less fluids. As bodily functions slowly decline and the intake of food and drink decrease, the output of fluids will also decrease. This is natural.
1. Palliative Care Curriculum for Undergraduates (PCC4U)
2. Palliative Care Curriculum for Undergraduates (PCC4U)
3. Palliative Care Education and Training Collaborative
https://palliativecareeducation.com.au/General Principles of Symptom Management
- For any symptom an underlying cause when possible should be sought to aid cause-specific management.
- History, clinical examination and investigations should be tailored to individual patient need and circumstances.
- Treatment plans must be fully discussed with patients and carers.
- Continuous symptoms require continuous treatments (not just PRN medications).
- Review treatment plans within an appropriate timeframe for the individual patient need and circumstance. Consider review every 24 hours unless there is reason to do so more or less frequently.
INCTR Palliative Care Handbook:
Scottish Palliative Care Guidelines
Palliative care
identifies and treats
symptoms which may be
physical, emotional,
spiritual or social.
EUTHANASIA
The term ‘euthanasia’ –
now more commonly replaced with
the term ‘assisted dying’ -
means any act or omission provided
at that person’s request
which is intended to cause death
with a view to eliminating suffering.
Examples of assisted dying
or euthanasia include:
i) administering deliberate overdoses of otherwise appropriate medications and
ii) unjustified withholding or withdrawal of life-sustaining measures.
This does not include:
• Giving doses of necessary pain relief, including opioids,
commensurate with a person’s clinical need.
Good pain management in skilled hands
neither under- nor over-doses the patient;
• Complying with a competent patient’s refusal of treatment; and/or
• Withholding or withdrawing life-sustaining treatments that are no longer effective or that do not benefit the patient.
Advance Care Directives or Plans can only
direct families and health professionals
to make a preferred choice between courses
of treatment that are both medically and legally
defensible.
Palliative Care and Hospice Care
TRIGGERS FOR PALLIATIVE CARE
https://pharmacopallcare.blogspot.com/2020/09/triggers-for-palliative-care-ika.html
Oxygen_in_Palliative_Care_FINAL.pdf
https://nwcscnsenate.nhs.uk/files/9814/5684/6563/Oxygen_in_Palliative_Care_FINAL.pdf
Implications of the Cost of End of life Care: A Review of the Literature - research-health-soa-eol-final.pdf
https://www.soa.org/globalassets/assets/Files/Research/Projects/research-health-soa-eol-final.pdf
strategy-full-document-final.pdf
https://www.ccdhb.org.nz/news-publications/publications-and-consultation-documents/strategy-full-document-final.pdf
Palliative-Care-Guidelines-in-Dementia-Final.pdf
https://www.cheshire-epaige.nhs.uk/wp-content/uploads/2019/02/Palliative-Care-Guidelines-in-Dementia-Final.pdf
Palliative Care Queensland submission to the 2019 Queensland Parliament Inquiry into aged care, end-of-life and palliative care and voluntary assisted dying - PCQ-2019-Qld-Inquiry-submission_final.pdf
https://palliativecareqld.org.au/wp-content/uploads/2019/09/PCQ-2019-Qld-Inquiry-submission_final.pdf
Palliative Care Social MediaToolkit 2018 FINAL.pdf
https://smhs.gwu.edu/cancercontroltap/sites/cancercontroltap/files/Palliative%20Care%20Social%20MediaToolkit%202018%20FINAL.pdf
DRAFT - Palliative Care Strategy 2010 -15 VER 23 FINAL.pdf
https://org.nhslothian.scot/Strategies/ladwinlothian/Documents/Palliative%20Care%20Strategy%202010%20-15%20VER%2023%20FINAL.pdf
MCC Palliative Care Resources FINAL.pdf
https://health.maryland.gov/phpa/cancer/cancerplan/SiteAssets/Pages/Palliative-Care-Resources/MCC%20Palliative%20Care%20Resources%20FINAL.pdf
In the United States, in states where assisted suicide is legal, insurance compa nies have refused to cover chemotherapy treatment for cancer patients, instead offering the insured assisted suicide drugs. 😔⬇️ not fun facts⬇️ https://t.co/dteBeWRmtW
— WHO Collaborating Centre in Salzburg, Austria 😷 (@CentreWho) June 29, 2021
Di Amerika Serikat, di negara bagian di mana bunuh diri yang dibantu adalah legal, perusahaan asuransi menolak untuk menanggung perawatan kemoterapi untuk pasien kanker, alih-alih menawarkan obat bunuh diri yang dibantu yang diasuransikan.
Bukan fakta yang menyenangkan. (@CentreWho on Twitter.com)
Bukan fakta yang menyenangkan. (@CentreWho on Twitter.com)
Ookay kan, Bro!
IKA SYAMSUL HUDA MZ
