When palliative care is provided
at all service levels
by interdisciplinary teams,
not only does quality of life improve
for the patient and family
but the burden on health services is lessened.
Families receiving support
in the community
through trained volunteer palliative care providers are
less likely to feel
they need to hospitalize their dying patient.
Providing palliative care
through teamwork at all levels
brings a more efficient
and effective use of resources.
A GUIDE TO SYMPTOM MANAGEMENT IN PALLIATIVE CARE
WMPCP Palliative Guidelines Now available for free to everyone that needs it. You may download it
http://www.wmcares.org.uk/
Whether you bring a dying loved one home or keep vigil at the hospital, you can take measures to provide comfort and relief at the end of life.
https://www.mayoclinic.org/healthy-lifestyle/end-of-life/in-depth/cancer/art-20047600
HYDRATION AND NUTRITION
A reduced need for food and fluids is
part of the normal dying process
and patients should be supported
to take food and fluids by mouth
for as long as tolerated.
Symptoms of thirst/dry mouth are
often due to mouth breathing
or medication/oxygen therapy
and good mouth care is essential.
Adults in the last days of life
need to have their hydration status assessed daily,
and have a discussion about the risks
and benefits of hydration options.
Dying is the one certain thing in life – we
will all die. Some people unexpectedly as a result of illness or
accident, and some gradually from a chronic illness or frailty.
https://www.rcn.org.uk/clinical-topics/end-of-life-careWithin a healthcare team are three levels of palliative care provision with increasing specialisation from level 1 to level 3:
- Level 1: Provided in any location or setting by all health care professionals as part of their role and using a palliative care approach.
- Level 2: Provided in any location, using a palliative care approach by health care professionals who have additional knowledge of palliative care principles and use this as part of their role.
- Level 3: Provided by health care professionals who work solely in palliative care, and who have extensive knowledge and skills in this specialty.
Distress caused by symptoms (physical, psychosocial or spiritual)
is actively pre-empted, and when it occurs, the response is timely and
effective. This includes prompt response to needs, regularly reviewing
the effectiveness of treatment, and ensuring the person, their family
and carers have timely access to specialist palliative care at all
times. The dignity of the person is prioritised at all times through a person-centred approach to their overall care.
https://www.health.qld.gov.au/__data/assets/pdf_file/0032/697046/PCare-National-Standards-2018a.pdfStudies have defined gaps in palliative care and the care of critically ill patients in the ICU, including the following:
- Untreated pain and other symptoms
- Unmet needs for care of families and loved ones
- Inadequate communication
- Conflict resolution among clinicians, patients, and families
- Divergence of treatment goals from patients and family preferences
- Inefficient resource utilization
- Clinician “moral distress” and burnout
Principles of Palliative Care
- Palliative care incorporates the whole spectrum of care — medical, nursing, psychological, social, cultural and spiritual. A holistic approach, incorporating these wider aspects of care, is good medical practice and in palliative care it is essential.
- The principles of palliative care might simply be regarded as those of good clinical practice, whatever the patient’s illness, wherever the patient is under care, whatever his / her social status, creed, culture or education.
“Most people who have a life-threatening condition
can benefit from palliative care, whether or not they are having active
treatment. Palliative care helps with personal, social and medical
problems associated with potentially mortal illness, especially . It assists families and carers and supports pain and other distressing symptomsthem in bereavement. It uses skilled approaches from a trained team, but often involves friends, family members and the wider community. Palliative care improves wellbeing and in some instances has even been shown to extend life”.
(David Clark 18 January 2019 - http://endoflifestudies.academicblogs.co.uk/)http://endoflifestudies.academicblogs.co.uk/controversies-in-palliative-care-a-matter-of-definition/
HYDRATION IN PALLIATIVE CARE
https://pharmacopallcare.blogspot.com/2020/09/hydration-in-palliative-care-ika.html
‘Palliative care’ is care for a person of any age who has a life-limiting illness.
Palliative care involves supporting and helping the person to live as comfortably and fully as possible.
- A ‘life-limiting illness’ is one that cannot be cured and may at some time result in the person dying (whether that is years, months, weeks or days away).
- Palliative care involves providing assistance at all stages of the life-limiting illness.
Palliative care is provided in the community, in hospices and in hospitals.
- It can be provided by all health care professionals, including GPs and district nurses – supported where necessary by specialist palliative care services.
- Hospices are the main providers of specialist palliative care services for people living in the community.
A comprehensive multi-professional tool
that guides and enables healthcare professionals to focus on quality
care in the last hours or days of life for the dying person, carer,
family/whanau, friends and staff members.
https://www.hospicetaranaki.org.nz/services-patient-and-carers-information/health-care-professionals/
- The role of palliative care at the end of life is to relieve the suffering of patients and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms patients experience.
- As death approaches, the symptom burden of a patient may worsen and require more aggressive palliation.
- As comfort measures intensify, so does the support provided to a dying patient’s family.
- Once death has occurred, the role of palliative care focuses primarily on the support of the patient’s family and bereavement.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241069/
Palliative
care is holistic, focused on the whole person and the physical, social,
emotional, and spiritual issues experienced by the patient and his or
her family caregivers.
Palliative care is:
Delivered: When needed, throughout a person’s life
Goal: Alleviating suffering of all kinds
Population Served: Anyone in need of specialized care due to a serious illness
Planning for end-of-life is a difficult and uncomfortable process. The earlier the planning, the better. This is true for the individual, loved ones, and the caretaker. End-of-life care includes planning financially and managing pain. Also, it involves selecting care professionals, discussing funeral wishes, and maintaining the best quality of life possible.
https://familydoctor.org/end-life-care/
Former cancer patient Thomas William “Bill” Hays had one of his dying wishes fulfilled when he witnessed the wedding of his daughter, Micaela, at his hospital bedside.
https://www.utsouthwestern.edu/ctplus/stories/2019/palliative-care.html
The American Society for Clinical Oncology (ASCO) recommends
considering the combination of palliative care with standard oncology
care early in the course of treatment for patients with metastatic
cancer and/or a high symptom burden.
Specific recommendations are as follows: - The time to start palliative care is as soon as a patient's cancer becomes advanced
- For newly diagnosed patients with advanced cancer, the Expert Panel suggests early palliative care involvement within 8 weeks after diagnosis
- Inpatients and outpatients with advanced cancer should receive dedicated palliative care services early in the disease course concurrent with active treatment.
END-OF-LIFE INDICATORS and INSTRUMENTS/TOOLS FOR QUALITY IN PALLIATIVE CARE:
- enrollment in palliative care within 6 months of death
- enrollment in palliative care within 3 days of death
- the edmonton symptom assessment system (esas) and the palliative performance scale (ppsv2), problem checklist are the most commonly used tools.
Medications at end of life
A range of medications will need to be considered at end of life to address worsening symptoms related to breathing, pain, saliva management and anxiety. The palliative care team should be actively involved to ensure optimal end of life care (MND Australia 2011).
Dosage and modes of administration of medications should be discussed with the palliative care physician.
- ☛ opioid analgesics - reduce cough reflex, relieve dyspnoea, control pain and help to reduce fear and anxiety
- ☛ anti-cholinergics - such as hyoscine hydrobromide and glycopyrrolate reduce saliva and lung secretions
- ☛ sedatives - such as diazepam, midazolam, clonazepam and chlorpromazine reduce anxiety
- ☛ oxygen - can be used to relieve the sensation of breathlessness
- ☛ Haloperidol - for terminal restlessness
The Institute of Medicine (IOM) offers the following definitions (2015):
- Specialty palliative care:
“Palliative
care that is delivered by health care professionals who are palliative
care specialists, such as physicians who are board certified in this
specialty; palliative-certified nurses; and palliative care-certified
social workers, pharmacists, and chaplains.”
- Primary palliative care (also known as generalist palliative care):
“Palliative
care that is delivered by health care professionals who are not
palliative care specialists, such as primary care clinicians; physicians
who are diseaseoriented specialists (such as oncologists and
cardiologists); and nurses, social workers, pharmacists, chaplains, and
others who care for this population but are not certified in palliative
care.”
https://www.nationalcoalitionhpc.org/Basic palliative care “is delivered by… primary care clinicians; physicians who are disease-oriented… and nurses, social workers, pharmacists, chaplains, and others who care for this population but are not certified in palliative care."
Specialty palliative care “is delivered by health care professionals who are palliative care specialists, such as physicians who are board certified in this specialty; palliative-certified nurses; and palliative care certified social workers, pharmacists, and chaplains."
specifically:
- physicians, including advanced practice nurses and physician assistants,
- nurses,
- social workers,
- chaplain,
- pharmacists, and
- volunteers.
Additional palliative care team members can include:
- rehab professionals (physical, occupational and speech therapists),
- dietitians,
- complementary and
- alternative medicine practitioners,
- child-life specialists,
- nutritionists,
- home health aides, and
- community health workers.
- It also frequently includes the referring physician and specialist, who contribute to the care planning process.
Always, patients and families are central to the focus and activities of the interdisciplinary palliative care team.
https://csupalliativecare.instructure.com/courses/
THE ‘SURPRISE’ QUESTION
Identification of patient approaching the end-of-life
The ‘surprise question’:
For patients with advanced disease
of progressive life-limiting conditions:
Would you be surprised
if the patient were to die
in the next few months,
weeks,
days?
The answer to this question should be
an intuitive one,
pulling together a range
of clinical,
co-morbidity,
social
and other factors
that give a whole picture
of deterioration.
If you would not be surprised,
then what measures might be taken
to improve the patient’s quality of life now
and in preparation
for possible further decline?
https://www.caresearch.com.au/caresearch/tabid/1507/Default.aspx#sur
PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT(POLST)
https://web.archive.org/web/20200729082108/https://dph.georgia.gov/document/document/here-2/download
Difference Between
Advance Directives and POLST
Okay kan, Bro!
