https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189385/
ESAS-r
If the patient cannot participate in the symptom assessment at all, or refuses to do so, the ESAS-r is completed by the caregiver alone. The caregiver assesses the remaining symptoms as objectively as possible. The following are examples of objective indicators:
Pain – grimacing, guarding against painful maneuvers
Tiredness – increased amount of time spent resting
Drowsiness – decreased level of alertness
Nausea – retching or vomiting
Appetite – quantity of food intake
Shortness of breath – increased respiratory rate or effort that appears to be causing distress to the patient
Depression – tearfulness, flat affect, withdrawal from social interactions, irritability, decreased concentration and/or memory, disturbed sleep pattern
Anxiety – agitation, flushing, restlessness, sweating, increased heart rate (intermittent), shortness of breath
Wellbeing – how the patient appears overall
If it is not possible to rate a symptom, the caregiver may indicate “U” for “Unable to assess” on the ESAS-r and ESAS-r Graph.
https://web.archive.org/web/20211104050454/https://www.interiorhealth.ca/sites/Partners/palliative/Documents/ESASr%20Guidelines.pdf
KEEP SYMPTOMS WELL MANAGED
Why is it important to keep symptoms well managed?
Symptoms can be distressing for people
and decrease their quality of life.
This is why we try to keep them well managed.
The severity of a symptom,
such as anxiety or nausea,
is often hard to measure.
Symptom severity is usually best judged
by listening to the person
when they describe
what they are feeling
or experiencing.
If pain or other symptoms
that cause discomfort are allowed to build up,
they can become much harder
to control than
if you take steps to manage them
at the first sign of their appearance
• this is what good symptom management is all about.
IN ANY GIVEN SITUATION WE MUST USE
Palliative care differs from Hospice care in that Palliative Care can be provided at any time during the illness and for as long as the patient needs this care. Hospice care is usually provided when the patient’s life expectancy is limited to months and the patient is not seeking aggressive treatment for their illness.
https://www.midlandhealth.org/main/palliative-care
It is estimated that 5–6% of the population have the complexity of need where they could potentially benefit from ACP. Individuals should be identified and offered interventions in a timely way to enable informed choice and ensure optimal outcomes.
https://ihub.scot/project-toolkits/anticipatory-care-planning-toolkit/anticipatory-care-planning-toolkit/guidance-for-health-and-social-care-professionals/considering-the-anticipatory-care-planning-process/
SYMPTOM MANAGEMENT
http://inctr-palliative-care-handbook.wikidot.com/table-of-contents
- ☛ 1. Is there an indication for the drug?
☛ 2. Is the medication effective for the condition?
☛ 3. Is the dosage correct?
☛ 4. Are the directions correct?
☛ 5. Are the directions practical?
☛ 6. Are there clinically significant drug-drug interactions?
☛ 7. Are there clinically significant drug-disease/condition interactions?
☛ 8. Is there unnecessary duplication with other drugs?
☛ 9. Is the duration of therapy acceptable?
☛ 10. Is this drug the least expensive alternative compared with others of equal usefulness?
https://cdn.ymaws.com/www.nehospice.org/resource/resmgr/imported/11SessionF2handouts.pdf
Pharmacokinetic considerations and recommendations in palliative care, with focus on morphine, midazolam and haloperidol
https://www.tandfonline.com/doi/full/10.1080/17425255.2016.1179281
Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study
https://www.jpsmjournal.com/article/S0885-3924(11)00065-0/fulltext
ADULT PALLIATIVE CARE SERVICES MODEL OF CARE FOR IRELAND
https://www.lenus.ie/bitstream/handle/10147/624170/Palliative-Care-Model-of-Care-2019.pdf?sequence=1&isAllowed=y
Site Map
https://www.palliativecareggc.org.uk/?page_id=991
Many people believe that they should put off using painkillers for as long as possible, and only take them when their pain gets unbearable. However, if pain is not treated it may become more difficult to control, so it's important to take any painkillers that you are prescribed in the way that your doctor advises.
https://www.nhsinform.scot/care-support-and-rights/palliative-care/symptom-control/controlling-pain
https://www.goodlifedeathgrief.org.uk/
What is Anticipatory Care Planning? Anticipatory Care Planning is about individual people thinking ahead and understanding their health.
https://ihub.scot/project-toolkits/anticipatory-care-planning-toolkit/anticipatory-care-planning-toolkit/
"My Anticipatory Care Plan"
https://ihub.scot/project-toolkits/anticipatory-care-planning-toolkit/anticipatory-care-planning-toolkit/documents/
Links to further information The following are links to some sites which may be useful if you are searching for information on Palliative Care. Resources to support good palliative and end of life care
https://www.palliativecarescotland.org.uk/content/links/
Imminence of Death
https://bit.ly/Imminenceofdeath
https://www.togetherforshortlives.org.uk/changing-lives/sharing-learning-networking/palliative-care-networks/
Care should be based on the assessed needs of the patient, the carers or family and not
https://www.aci.health.nsw.gov.au/palliative-care-blueprint/the-blueprint/essential-components/essential-component-5
Standard Framework and Palliative Care
https://sites.google.com/view/standard-framework-and-pc/home
The ‘Caring for people in the last days and hours of life’ Guidance and associated 4 principles provide a framework for further planning and development across health and care settings in Scotland.
https://www.gov.scot/publications/caring-people-last-days-hours-life-guidance/
Palliative Care Education – Anytime, Anywhere
https://csupalliativecare.org/programs/
Indicators specify a minimum set of measures that demonstrate person-centred, safe and effective care is being delivered. Patients, carers, third sector and healthcare professionals helped to develop the indicators for palliative and end of life care.
http://www.healthcareimprovementscotland.org/our_work/person-centred_care/palliative_care/palliative_care_indicators.aspx
Palliative and End of Life Care Network for Lancashire and South Cumbria
https://www.england.nhs.uk/north-west/north-west-coast-strategic-clinical-networks/our-networks/palliative-and-end-of-life-care/palliative-and-end-of-life-care-network-for-lancashire-and-south-cumbria/
Pharmacological management of symptoms for adults in the last days of life
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/medicines+and+drugs/pharmacological+management+of+symptoms+for+adults+in+the+last+days+of+life
http://www.northerncanceralliance.nhs.uk/wp-content/uploads/2018/11/NECNXPALLIATIVEXCAREX2016.pdf
Guidance and Resources
https://www.northerncanceralliance.nhs.uk/pathway/palliative-and-end-of-life-care/supportive-palliative-and-end-of-life-care-resources/
Health Professionals
https://www.caresearch.com.au/caresearch/tabid/55/Default.aspx
Colour-coded labelling system
https://www.caringathomeproject.com.au/tabid/5332/Default.aspx
http://www.cheshire-epaige.nhs.uk/document-library/
http://eolp.co.uk/
Restlessness and agitation
- Exclude reversible causes e.g. urinary retention, drug therapy, hypercalcaemia
- Treat contributory symptoms e.g. pain. Ensure calming environment. If symptoms persist consider drug therapy:
- Midazolam 2.5-5mg stat and 10-120mg/24hrs (SC)
- Levomepromazine 12.5-25mg stat and 12.5-150mg/24hrs (SC)
- Haloperidol 1.5-3mg stat and 5-10mg/24hrs (SC)
- Phenobarbitone 100-200mg stat (IM) and 600mg-1200mg/24hrs (under specialist palliative care supervision only)
Alternatives to regular medication normally given via a syringe pump when this is not available
https://www.palliativecareguidelines.scot.nhs.uk/guidelines/symptom-control/alternatives-to-regular-medication-normally-given-via-a-syringe-pump-when-this-is-not-available.aspx
Links to best-practice tools from around the world to support primary care providers in the delivery of palliative care.
http://ocp.cancercare.on.ca/cms/One.aspx?portalId=77515&pageId=76967
http://www.inctr.org/resources/inctr-publications/index.html
http://www.inctr.org/fileadmin/user_upload/inctr-admin/Media/Palliative_Care_Complete.pdf
Clinical resources, training and education
https://northwestpalliative.com.au/resources/clinical-resources-training-education/
Paediatric Palliative Care Guidelines 4th Edition
http://paed.pallcare.info/
Palliative care language and definitions
https://northwestpalliative.com.au/resources/palliative-care-definitions/
The AMBER Care Bundle
http://cec.health.nsw.gov.au/keep-patients-safe/end-of-life-care/amber-care
SG Strategic Framework for Action
https://www.palliativecarescotland.org.uk/news/strategic-framework-for-action/update-may-2018/
https://palliativecareeducation.com.au/my/
Learning modules
http://www.pcc4u.org/learning-modules/core-modules/module-1-principles
Palliative and Supportive Care Education (PaSCE)
https://www.cancerwa.asn.au/professionals/pasce/
End of Life/Palliative Care Quiz
- The focus of palliative care is to decrease pain and suffering and provide comfort and support for people with serious illnesses. But not all people who receive palliative care are terminally ill. In fact, some are undergoing treatments to cure their illness, but they need help controlling nausea, fatigue, pain or other symptoms. Hospice care, which is for people who are facing the end of their life, is a specialized part of palliative care.
- The philosophy of hospice is that people who are facing the end of their life should be as comfortable as possible. For many, this means remaining in their own home. Hospice care also may be provided at a hospice facility, in the hospital or in a nursing home.
- Hospice care is about giving people control, dignity and comfort in their final days. The focus is on how to make every day be as good as possible. Hospice care doesn't prolong life or hasten death, but it can help ease the fear, pain and loneliness that terminally ill patients and their families face.
- People with a terminal illness who choose hospice will continue any medical care that maintains or improves their lives. They also are treated for pain, nausea and other symptoms that cause distress. But they stop trying to do everything possible to extend their life, focusing instead on enhancing the quality of the time they have left.
- Pain, loss of appetite, difficulty breathing and other symptoms cause people distress. The goal of palliative care is to manage and relieve those symptoms. In some cases, relieving symptoms helps people recover faster. In other cases, symptoms are managed to make the end of life more comfortable.
- Hospice care is a personal choice. You can accept it or not. And you can choose to stop hospice care once you've started it.
- People are typically eligible for hospice care if they are likely to have 6 months or less to live based on the natural course of their illness. Hospice teams help people maintain quality of life, dignity and control. Unfortunately, hospice is sometimes viewed as giving up, and the decision to ask for hospice help comes just days or weeks before death, which means people miss out on months of comfort and support.
- Hospice workers can provide bereavement services, grief counseling, spiritual counseling and emotional support to families. They help loved ones understand the dying process and can help arrange other services, such as preparing meals or running errands. Some programs have respite care to give caretakers a break.
- Hospice and end-of-life teams can involve a large group of people that includes counselors, physical therapists, doctors, pain specialists, nurses, spiritual advisers, social workers and aides to help with bathing and other daily needs. Hospice doctors often work closely with a patient's personal physician to set up care programs. Family, friends, loved ones and volunteers often provide much of the day-to-day support.
- Medicare, private insurance and, in most states, Medicaid cover most of the expenses associated with hospice care. Hospice services also may be covered by veterans' benefits. Some hospice programs offer a sliding fee for patients with limited incomes.
http://www.ataglanceseries.com/nursing/palliativecare/mcqs.asp
Palliative care Trivia Quiz
https://www.proprofs.com/quiz-school/story.php?title=palliative-care
Chapter 11: Multiple choice questions
http://wps.pearsoned.co.uk/ema_uk_he_PX_devpsych/206/52953/13556061.cw/content/index.html
OPIOID CONVERSION CHART
https://www.weld-hospice.org.uk/wp-content/uploads/2019/07/Opioid-Conversion-Chart-colour.pdf
National Service Frameworks for heart failure, renal failure and other conditions are increasingly emphasising the importance of providing good palliative care to these patient groups as well as to those with cancer. The material in this Handbook is intended to apply across a range of diagnoses.
https://www.weld-hospice.org.uk/professionals/palliative-care-handbook/
Steve Pantilat, MD, Palliative Care Part 2: PALLIATION OF SYMPTOMS
Oxycodone
10mg oral oxycodone = 5mg SC oxycodone = 10mg SC morphine
= 20mg oral morphine
Oxycodone has good oral bioavailability. The example above illustrates the dose conversion when oxycodone is regarded as being 2 times more potent than oral morphine.
Oxycodone is an alternative option if morphine is not tolerated. Care should be taken to ensure clarity when prescribing immediate release capsules or modified release tablets. The modified release tablets also deliver a small dose which is immediate release.
https://web.archive.org/web/20180902104037/http://wmpcg.co.uk/?page_id=440
The diversity of characteristics of terminal disease:
• Disease prognosis (newly diagnosed or the final days of life)
• Physical function (walking, weight bearing or bedbound)
• Lymphoedema symptoms (mild or severe swelling, cellulitis, lymphorrhoea, ascites, chylous reflux)
• Other symptoms (breathlessness, pulmonary embolus, deep vein thrombosis, fungating wounds)
• Adjuvant treatments (radiotherapy, chemotherapy)
• Treatment consent (advanced treatment directives, power of attorney, unconsciousness).
Quick Reference Guide for Symptom Management
Okay kan, Bro!
IKA SYAMSUL HUDA MZ
