There are three main such trajectories, in addition to sudden, unpredictable death:• rapid – typically cancer
• erratic – typically organ failure
• protracted – typically frailty, co-morbidity and dementia.
https://bit.ly/2WyMJD0
People who are nearing the end of their life following the three main trajectories of illness for expected deaths:
Rapid predictable decline (e.g. cancer)
Erratic decline (e.g. organ failure)
Gradual decline (e.g. frailty and dementia)
Additional contributing factors when considering prediction of likely needs include:
Current mental health
Co-morbidities
Social care provision
https://library.nshealth.ca/PalliativeCare/Identify
MORE THAN JUST PAIN RELIEF
Palliative care is more than just pain relief.
It includes addressing
the physical,
psychosocial
and emotional suffering
of patients with serious advanced illnesses
and supporting family members
providing care to a loved one.
About one third
of those needing palliative care
suffer from cancer.
Others have progressive illnesses
affecting their
heart,
lung,
liver,
kidney,
brain,
or chronic, life-threatening diseases
including HIV
and drug-resistant tuberculosis.
https://www.who.int/mediacentre/news/releases/2014/palliative-care-20140128/en/
Palliative care is
an approach that improves the quality of life
of patients (adults and children)
and their families who are
facing problems associated
with life-threatening illness.
It prevents and relieves suffering
through the early identification,
correct assessment
and treatment of pain and other problems,
whether physical,
psychosocial
or spiritual.
Palliative care is
a crucial part of integrated,
people-centred health services,
at all levels of care:
it aims to relieve suffering,
whether its cause is
cancer,
major organ failure,
drug-resistant tuberculosis,
end-stage chronic illness,
extreme birth prematurity
or extreme frailty of old age.
Worldwide,
only about 14% of people
who need palliative care
currently receive it.
The quality of life
of patients and their families
who are facing problems associated
with life-threatening illness,
whether physical,
psychosocial
or spiritual are
greatly improved
by palliative care.
https://www.who.int/news-room/facts-in-pictures/detail/palliative-care
There is a substantial gap
in funding and availability
of palliative care amongst
country groups by income.
There is an urgent
need to scale up
palliative care services
in low- and middle-income countries
through policies,
resources,
services in primary care
and access to morphine.
Expert treatment of pain and other symptoms
- Pain, nausea, breathing difficulties, anxiety, and difficulty sleeping can make it hard to enjoy life. We can suggest treatments that address these problems.
Emotional and spiritual support for you and your family
- A serious illness can be sad and frightening for both patient and family. Talking can be helpful, as can medication. Palliative care can help family members support one another, especially when young children are involved.
Help in navigating the healthcare system
- The healthcare system is often confusing and overwhelming. We can help you find resources and figure out what you need.
Guidance and support with difficult treatment choices
- Sometimes, patients and families face difficult choices about future treatments: Does the benefit of treatment outweigh the burdens? Is a particularly risky intervention worthwhile? We can help patients and families think about and discuss these concerns.
Help in coordinating care at home and in the community
- Community resources can make it possible for you to receive care at home. We can help you find services that meet your goals, and coordinate symptom management and psychosocial support plans with community resources.
Balancing competing ethical principles or arguments is difficult but necessary.
Some basic rules for ethical deliberation and decision making are:
- ☛ Inclusiveness: seek input from all those affected.
-
- ☛ Communication: ensure two-way communication with all affected people.
-
- ☛ Transparency: in linguistically and culturally appropriate ways, explain both the decisions themselves and how decisions are made. Strictly avoid corruption or even any appearance of corruption.
-
- ☛ Accountability: provide a mechanism for any affected person to challenge a decision and a due process for disputes to be resolved.
-
- ☛ Consistency: allocation principles should be applied consistently.
-
- ☛ Ensuring comfort: ensure that palliative care is accessible for patients who cannot be saved with existing resources.
To support clinical areas the specialist palliative care team provide each clinical area that may care for patients who have a palliative diagnosis Information for professionals
https://bit.ly/2WQhkelThe PDQ is a simple, open-ended question: “What do I need to know about you as a person to give you the best care possible?”
https://bit.ly/2T8Y3DM
4 symptoms commonly require medications for relief at the EOL:
- pain and/ or breathlessness
- anxiety or agitation
- respiratory secretions
- nausea or vomiting
Specialist Palliative Care (SPC) services have an important role in supporting other healthcare providers in hospital, residential care and community settings to meet the palliative care needs of persons with life-limiting conditions and their families.
https://www.hse.ie/eng/
SPC (synonyms: specialized or specialty palliative care) Normally, SPC is provided by multi-professional teams on inpatient wards or by consultation teams within hospitals, in outpatient clinics, and as palliative home care
https://systematicreviewsjournal.biomedcentral.com/End-of-life care (EOLC) is defined as the timeframe of the last year of life for patients, during which their supportive and palliative care needs are identified and met.https://academic.oup.com/
Adult patients considered being within the last 12 months of life and having specialist palliative care needs and their families.https://www.nhft.nhs.uk/spc/
It is important to note that patients can be re-referred should they develop specialist palliative care needs once more.
https://olh.ie/our-services/Common Hospice Medications
- Acetaminophen.
- According to a study published by the National Institutes of Health (NIH), acetaminophen is the most commonly prescribed hospice medication. Known by the brand name Tylenol, it is used to reduce fever and pain.
- Anticholinergics.
- Anticholinergic and antispasmodic drugs are used to regulate contraction and relaxation of muscles.
- Antidepressant medications.
- ntidepressants are designed to help relieve symptoms of depression, social anxiety disorder, anxiety disorders, seasonal affective disorder, and dysthymia, or mild chronic depression, in addition to other conditions. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and noradrenaline reuptake inhibitors (SNRIs) are the most commonly prescribed types of antidepressants.
- Anxiolytics.
- As their name suggests, these medications are used to treat anxiety. However, they can be used to treat other conditions, including alcohol withdrawal symptoms, depression, insomnia, itching, nausea, panic disorder, seizures, and vomiting.
- Atropine Drops.
- In a hospice setting, atropine eye drops are used instead of injections to reduce excess mucus secretion and saliva production.
- Fentanyl.
- Fentanyl is a hospice medication used to help relieve severe, ongoing pain such as that caused by cancer. Patients with consistent pain, particularly those with difficulty swallowing, are often prescribed a long-acting Fentanyl transdermal patch.
- Haldol (also Known as Haloperidol).
- Haldol is an antipsychotic drug used in the treatment of terminal agitation and delirium.
- Lorazepam (Ativan).
- Lorazepam is used to treat anxiety. Per the previously mentioned study, Lorazepam was the second most-prescribed drug among hospice patients.
- Prochlorperazine.
- Prochlorperazine suppositories and tablets are used to control severe nausea and vomiting; tablets are also used to treat the anxiety that could not be controlled by other medications.
- Roxanol (Morphine Sulfate).
- Commonly known as morphine, this opioid drug is a narcotic analgesic used to control severe acute and chronic pain.
Palliative Sedation in Palliative Care
https://bit.ly/PalliativeSedationinPalliativeCare
Di Perawatan Paliatif mengharuskan kita semua setiap hari lebih baik menyempatkan diri membaca informasi atau edukasi tentang perawatan paliatif. Meskipun cuma membaca seuntai paragraf kalimat tentangnya. Selamat belajar, berdoa dan bekerja.
Management of Subcutaneous Infusions in Palliative Care
It is important to the successful commencement of an infusion that breakthrough medication is provided and used as needed in the first 48 hours after commencement. If symptoms continue to be unrelieved a review of medications being infused should be made. Check to ensure the medication is appropriate, that an appropriate dose has been prescribed and that the correct dosage has been prepared and is being infused.
https://www.health.qld.gov.au/cpcre/subcutaneous/learn_modulesDue to reports of tissue necrosis when administered subcutaneously, the following medications should be avoided via this route:
AntibioticsDiazepamChlorpromazineProchlorperazine
Patients
requiring palliative care at the end of life may benefit from
subcutaneous administration for the treatment of infection when the oral
route is not possible or when venous access is difficult.
Palliative patients with infections can be treated with ceftriaxone, cefepime, ampicillin, amikacin, tobramycin, ertapenem and teicoplanin administered subcutaneously when appropriate off-label use authorisation has been obtained and a benefit assessment performed.
The term life-limiting illness is used to describe illnesses where it is expected that death will be a direct consequence of the specified illness.
Such illnesses may include, but are not limited to:- cancer
- heart disease
- chronic obstructive pulmonary disease
- dementia
- heart failure
- neurodegenerative disease
- chronic liver disease
- renal disease.
http://www.pcc4u.org/learning-modules/core-modules/module-3-assessment/1-illness-trajectory/activity-1-life-limiting-illnesses/
Hypodermoclysis (HDC,
subcutaneous fluid infusions) has become a widely accepted route for
parenteral hydration. When parenteral hydration is indicated in dying
patients, clinicians are generally faced with a decision to use HDC or
intravenous (IV) hydration.
https://pallipedia.org/hypodermoclysis/
Advantages of HDC over IV:
Starting and maintaining a subcutaneous infusion catheter is relatively
pain-free. It can be done by trained patients or family caregivers,
preventing the need for frequent skilled nursing visits or trips to
medical centers to maintain a working IV.
https://www.mypcnow.org/fast-fact/hypodermoclysis/
In hospice and palliative care, patients often need medications to control symptoms such as pain, nausea, or difficulty breathing. Sometimes patients are not able to take these medications by mouth. Now there is a new option that allows medications to be given comfortably, easily, and effectively.
https://www.macycatheter.com/hospice-palliative-care/
Subcutaneous administration of hydration and drugs when
used with proper education, training, and followed up by home care
programs is a useful strategy for delivering care at home for optimal
symptom control for patients receiving palliative care.
https://ascopubs.org/doi/abs/10.1200/JCO.2018.36.34_suppl.49
Collaborative care and support planning (CCSP) offers a framework, which
recommends a proactive holistic, flexible, and tailored approach to
care, and recognises the individual as an expert in their own care. This
toolkit provides a collection of relevant tools and information to
assist members of the primary care team to implement the six-step model
of collaborative care and support planning.
https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/collaborative-care-and-support-planning-toolkit.aspxWho is the Palliative and End of Life Care Toolkit for?
The Palliative and End of Life Care Toolkit may be used by any general practice in the UK. The resources it provides can be used by healthcare professionals, informal carers, patients, and those close to someone nearing the end of life.
https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/palliative-and-end-of-life-care-toolkit.aspxThe Support Needs Approach for Patients
The Support Needs Approach for Patients (SNAP) is a
health care intervention which seeks to enable person-centred care for
patients with progressive conditions. SNAP uses an evidence-based
validated tool, known as the SNAP tool, to help patients identify and
express their support needs which are then discussed with their health
care professional.
https://thesnap.org.uk/The SNAP tool
SNAP uses a brief, yet comprehensive, evidence-based validated tool
which comprises 15 questions based on areas in which patients with
progressive disease commonly say they require support. The SNAP tool is
completed by the patient to help them consider and express their support
needs, and the completed tool is then used as the basis of a needs-led
conversation with their health care professional.
An inspection copy of the SNAP tool is free to download. Recent literature has documented that patients have unmet spiritual needs, both in the inpatient and outpatient setting, and that even patients who report no active religious affiliation report spiritual needs.https://www.jpsmjournal.com/article/S0885-3924(12)00068-1/fulltext
ORAL PROBLEMS
Oral problems are common in palliative care patients.
Careful assessment and early intervention are vital
in order to optimize patient comfort and prevent
more serious problems and complications.
Teeth and tongue should be cleaned at least twice daily
for about 2 minutes wish a small/medium head toothbrush
and fluoride toothpaste.
Any excess toothpaste should be spat out,
but the mouth should not be rinsed with water immediately
after brushing as this washes away
the remaining toothpaste
and reduces its protective effects.
Ooookay kan, Bro!
