https://pallipedia.org/total-pain/
DEFINISI LAMA (TAHUN 2000)
Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems is paramount. The goal of palliative care is achievement of the best possible quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness, in conjunction with anticancer treatment.
- ☛ afirms life and regards dying as a normal process neither hastens nor postpones death;
- ☛ provides relief from pain and other distressing symptoms;
- ☛ integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death;
- ☛ offers a support system to hclp the family cope during the patient's illness and in their own bereavement.
http://apps.who.int/iris/bitstream/10665/37896/1/9241544821.pdf
IAHPC. Global Consensus based palliative care definition. (2018).Houston, TX: The International Association for Hospice and Palliative Care.
Retrieved from https://hospicecare.com/what-we-do/projects/consensus-based-definition-of-palliative-care/definition/
Palliative care is the active holistic care of individuals across all ages with serious health-related sufferingi due to severe illnessii, and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers.
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（1） Alleviate pain and other distressing symptoms
（2） Provide high regard to human life and pay respect to the “course of death,” which all people will experience
（3） Do not unnaturally prolong life in a manner not desired by the patients or their family and do not intentionally cause death
（4） Offer mental and social support as well as spiritual care and help the patients live their life positively until the end
（5） Help the family to overcome various difficulties throughout the course of patients’ illnesses and after they die
Definisi perawatan paliatif: Perawatan paliatif adalah jenis perawatan yang diberikan bekerja sama dengan para profesional di bidang medis dan kesejahteraan serta berbagai disiplin ilmu lainnya selama perjalanan penyakit terlepas dari tempat perawatan akhir hidup untuk meningkatkan QOL pasien dengan penyakit yang mengancam jiwa dan sulit disembuhkan beserta keluarganya. Perawatan paliatif diberikan agar pasien dan keluarganya dapat hidup dengan bermartabat dan senyaman mungkin. Lima item berikut diperlukan untuk perawatan paliatif:
1） Mengurangi rasa sakit dan gejala menyedihkan lainnya
2） Menghargai kehidupan manusia dan menghormati “jalan kematian”, yang akan dialami semua orang
3） Jangan memperpanjang hidup secara tidak wajar dengan cara yang tidak diinginkan oleh pasien atau keluarganya dan tidak dengan sengaja menyebabkan kematian
4） Menawarkan dukungan mental dan sosial serta perawatan spiritual dan membantu pasien menjalani hidup mereka secara positif sampai akhir
5） Membantu keluarga mengatasi berbagai kesulitan selama perjalanan penyakit pasien dan setelah mereka meninggal
ICU FAMILY MEETING
By ICU day 3,
there should be an ICU family meeting
to address further questions
regarding the patient’s condition
as well as to offer social work
and spiritual support.
Here it is important to assess
if further need
for palliative care is present,
and an official palliative care consult
should be placed accordingly.
An official consult
would then lead
to an interdisciplinary
family meeting.
Weekly follow-up meetings
to further discuss
goals of care
and the possibility
of end-of-life care
are recommended.
https://www.researchgate.net/publication/347210273_Palliative_Care
Palliative care - general issues: Summary
Palliative care is defined as the active holistic care of people with advanced, progressive illness.
Professionals providing general palliative care services should:
- Be involved as early as possible after diagnosis.
- Aim to meet the needs of the patient and their family within the limits of their knowledge and competence.
- Seek specialist advice or refer the patient to specialist services, when necessary.
During the course of the illness, the patient's needs as well as the needs of their family or carers, should be assessed (and managed) at key points (e.g. at the time of diagnosis, around treatment episodes, as treatments end, at the time of a relapse, and when death is approaching). This includes assessing and managing:
- Preferred care setting.
- Anticipatory prescribing.
- Managing common physical symptoms such as nausea and vomiting or breathlessness.
- Psychological needs.
- Social needs (e.g. help with personal care, housework, and shopping).
- The needs of the family and carers.
An attempt should be made to estimate the patient's prognosis so that appropriate adjustments can be made to care in the terminal phase.
- The terminal phase may last hours to several days.
- People are likely to be in the terminal phase of their illness when they show certain signs including deteriorating day by day or faster because of their underlying condition, and/or expressing a realization that they are dying.
Effective communication (verbal and written) with the patient, their carers, and other healthcare professionals is very important including an individualised care plan.
- The patient should be given the opportunity to discuss topics important to them (e.g. advance care planning issues and estimated prognosis).
- Emergency contact numbers and information on what to do when death occurs should be provided to family and carers.
Care of people with advanced cancer:
- Should be based on locally agreed protocols and guidelines, delivered within the context of a managed system or pathway.
- Requires a multidisciplinary team because of the potential multidimensional nature of problems in palliative care.
https://cks.nice.org.uk/topics/palliative-care-general-issues/
Does palliative care mean that you're dying? Not necessarily.
It's true that palliative care does serve many people with life-threatening or terminal illnesses.
But some people are cured and no longer need palliative care. Others move in and out of palliative care, as needed.
https://www.webmd.com/palliative-care/when-is-palliative-care-appropriate#1
So, in order to further palliative care services in India, all the specialities should come together and embrace palliative care as an approach, rather than a competitive speciality
https://web.archive.org/web/20200903071951/https://www.ciplapalliativecare.org/wp-content/uploads/Hospital-based-Palliative-care_-A-Case-for-Integrating-Care-with-Cure1.pdf
VALUES
Palliative care services are provided based on the following values:
The natural process of death
as a normal part of life
provides for personal
growth through experience
and self-actualization.
Each person is unique,
autonomous
and capable of self-determination.
The need to address
the person’s and family suffering,
expectations,
needs,
hopes
and fears.
The person/family’s dignity
and integrity is
supported and maintained.
Care and/or services are provided
when the person and/or family accepts them.
Care is guided by quality of life
as defined by the person
or family unit.
Care and/or services are provided
within the parameters
of therapeutic relationships
Communities are an essential component
of a unified response
to relieve suffering.
Overall: Presence of a Serious, Chronic Illness
- ☛ Declining ability to complete activities of daily living
- ☛ Weight loss
- ☛ Multiple hospitalizations
- ☛ Difficult to control physical or emotional symptoms related to serious medical illness
- ☛ Patient, family or physician uncertainty regarding prognosis or goals of care
- ☛ Requests for futile care
- ☛ DNR order conflicts
- ☛ Use of tube feeding or TPN in cognitively impaired or seriously ill patients
- ☛ Limited social support and a serious illness (e.g., homeless, chronic mental illness)
- ☛ Patient, family or physician request for information regarding hospice appropriateness
- ☛ Patient or family psychological or spiritual distress
According to the Institute of Medicine (2001, pp. 5-6), quality of care can be considered within six dimensions:Electronic Proactive Assessment and Information Guide for End of Life (EPaige)
https://bit.ly/EPaige
- Safe – avoiding injuries to patients from the care that is intended to help them.
- Effective – providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit.
- Patient-centred – providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
- Timely – reducing waits and sometimes harmful delays for both those who receive and those who give care.
- Efficient – avoiding waste, including waste of equipment, supplies, ideas, and energy.
- Equitable – providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
Level 3 – Specialist Palliative Care
- Specialist palliative care services are those services whose core activity is limited to the provision of palliative care. These services are involved in the care of individuals with more complex and demanding care needs, and consequently, require a greater degree of training, staff and other resources. Specialist palliative care services, because of the nature of the needs they are designed to meet, are analogous to secondary or tertiary health care services.
Islamic faith community
- The name Islam is from a root word meaning “peace” and “submission,” and Islam teaches one can only find peace by submitting in heart, soul and deed to the Almighty God, who is called Allah in Arabic.
- Muslims believe in Jesus’ virgin birth, the holiness of his mother Mary, and his miracles. They believe he was a prophet like all other prophets, not the Son of God.
- Health-care workers are considered God’s agents of healing, whereas final healing comes from God alone.
- Privacy is very important, especially with mixed gender health-care professionals present.
- Muslims are forbidden to eat pork, foods prepared with alcohol, or to drink alcohol.
- While in the hospital, many Muslims may still wish to perform their five daily prayers. Assistance may be needed to wash prior to prayer, especially if the patient is bedridden.
- The most accepted Muslim belief is to perform all medical care if the possibility of cure exists but that prolonging of medical futility and suffering is not warranted.
- Quick burial is mandatory and autopsies are generally denied unless absolutely necessary.
- Support for the grieving family is important and follow up contact is helpful. Organ donation is acceptable and may offer comfort.
- Muslims do not believe in abortion unless the mother’s life is in jeopardy.
- Euthanasia is considered murder.
Palliative care for CKD/ESRD patients: Need for a systematic approach
☛ Pain and symptom assessment/management
☛ Shared decision-making for informed consent
☛ Patient-specific estimates of prognosis using the surprise question
☛ Timely discussions prompted by prognosis
☛ Inclusion of family/legal agent in discussions
☛ Completion of advance directives
☛ Completion of physician orders for life-sustaining treatment (POLST)
☛ paradigm form as appropriate
☛ Immediately actionable medical orders
☛ Transferrable throughout health care setting
☛ Referral to hospice when indicated
Components of a dialysis facility palliative care program
1. Palliative care focus
☛ a. Educational activities, including dialysis unit in-service trainings
☛ b. Quality improvement activities, including morbidity and mortality conferences
☛ c. Useof the “Would you be surprised if this patient died within the next year?” question to identify patients appropriate for palliative care
☛ d. Collaboration with local hospice programs to coordinate a smooth transition to end-of-life care
2. Pain and symptom assessment and management protocols
3. Systematized advanced care planning
4. Psychosocial and spiritual support to patients and families, including the use of peer counselors
5. Terminal care protocols that include hospice referral
6. Bereavement programs for families that include memorial services
Pain medications for use in advanced kidney failure
Recommended
☛ Fentanyl
☛ Methadone
☛ Hydromorphone
☛ Acetaminophen
☛ Gabapentin
Use with caution
☛ Tramadol
☛ Hydrocodone/oxycodone
☛ Desipramine/nortriptyline
Do not use
☛ Morphine
☛ Codeine
☛ Meperidine
☛ Propoxyphene
Identification and Assessment Tools in Palliative Care Services
https://bit.ly/IdentificationToolsPC
Hip Fracture: A Trigger for Palliative Care in Vulnerable Older Adults
- Hip fracture most commonly affects older adults and causes devastating consequences including pain, immobilization, functional decline, delirium, and death. Among those in the Medicare population who sustain hip fractures, 13% die within 3 months and 24%die within 12months. Of thosewhosurvive to 6months, only50% recover prefracture ability to performactivities of daily living.
- Hip fracture has a tremendously deleterious impact onthe survival and functional outcomes of the residents of longterm nursing homes. A palliative care approach is highly appropriate and should be initiated at the onset of hip fracture in the clinical care of this most vulnerable subset of older adults.
Steve Pantilat, MD, Palliative Care Part 4: PSYCHOSOCIAL SUPPORT
When the subject of palliative care is approached,
we inevitably associate it with cancer.
This idea is reflected in the definition developed
by the World Health Organization in 1990,
which provided for the use
of this type of care only for cancer patients.
However, this definition was revised in 2002
and redefined palliative care.
Therefore, palliative care aims not only
to follow up cancer patients and their families,
but also people with other chronic diseases
without possibility of cure.
Symptomatic improvement,
improved quality of life
and patient satisfaction are
some of the objectives of these units.
https://web.archive.org/web/20210102053618/http://medcraveonline.com/HPMIJ/HPMIJ-02-00102.pdf
Why is Palliative Care Needed?
Palliative Care can provide numerous benefits
for patients, their families and caregivers.
Helps you understand your disease process,
prognosis and your current plan of care.
Clarifies goals and treatment options.
Offers guidance for difficult
and complex medical decisions.
Provides you with adequate time
to discuss and address complex medical decisions.
Optimizes quality of life by anticipating,
preventing, and treating suffering
by addressing physical,
emotional,
social,
and spiritual needs.
Helps coordinate your care
with your multiple healthcare providers
and improves communication.
https://www.wmhs.com/palliative/
- I have the right to be treated as a human being until I die.
- I have the right to be cared for by those who can maintain a sense of hopefulness however changing its focus may be.
- I have the right to express my feelings and emotions about my approaching death in my own way.
- I have the right to participate in decisions concerning my care.
- I have the right to expect continuing medical and nursing attention even though ‘cure’ goals must be changed to ‘comfort’ goals.
- I have the right not to die alone.
- I have the right to be free from pain.
- I have the right to have my questions answered honestly.
- I have the right not to be deceived.
- I have the right to have help from and for my family in accepting my death.
- I have the right to die in peace and with dignity.
- I have the right to retain my individuality and not be judged for my decisions, which may be contrary to beliefs of others.
- I have the right to discuss and enlarge my religious and or spiritual experiences, whatever they may mean to others.
- I have the right to expect that the sanctity of the human body will be respected after death.
- I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to understand my needs and will be able to gain some satisfaction in helping me face my death.
https://web.archive.org/web/20200806224317/https://www.hospice.org.nz/wp-content/uploads/2019/03/2_Ethical_Workbook_2015_F.pdf
Oookay kan, Bro!
