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Palliative Care.

One of the main goals of medicine is to provide comfort and relief from pain and suffering. Unfortunately, a cure is not always possible particularly in this era of chronic diseases, and the role of physicians has become limited to controlling and palliating symptoms..

What is palliative care?. Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual - World Health Organization ..

In 2018, the International Association for Hospice & Palliative Care put forth a consensus definition of palliative care as: T he active holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life. It aims to improve the quality of life of patients, their families and caregivers..

History. It evolved as a result of growing public concern and dissatisfaction with the care of dying patients in the 1960’s and 1970’s. At that time, oncologists were preoccupied with curative interventions and were not concerned much about end of life care. Studies conducted at the time indicated that medical care provided to terminally ill patients did not exist or were suboptimal at best . Dame Cicely Saunders, widely recognized as the founder of palliative care, reported a similar experience. 6 She founded the first modern hospice, St. Christopher’s Hospice, in the UK in 1967. The establishment of this hospice was a major turning point that inspired physicians all over the world to be trained in this new field and establish palliative care in their own countries ..

Palliative medicine became a recognized medical subspecialty in Australia, New Zealand, the UK, Ireland, the USA, and several other countries.  Training became structured with the establishment of fellowship training programs..

Each year, an estimated 40 million people are in need of palliative care; 78% of them people live in low- and middle-income countries. Worldwide, only about 14% of people who need palliative care currently receive it. The global need for palliative care will continue to grow as a result of the ageing of populations and the rising burden of noncommunicable diseases and some communicable diseases..

Who needs Palliative Care?. Historically, palliative care services were focused on individuals with incurable cancer , but this framework is now applied to other diseases, like severe heart failure , chronic obstructive pulmonary disease and multiple sclerosis and other neurodegenerative conditions..

Goal. To improve quality of life of individuals with serious illness, any life-threatening condition which either reduces an individual's daily function or quality of life or increases caregiver burden, through pain and symptom management, identification and support of caregiver needs, and care coordination ..

Why PC is needed ?. Provide comfort and relief of distressing factors. Provide support to patients and family members facing all issues . P revent and minimize suffering by early identification, impeccable assessment and immediate intervention of related problems. P romote understanding and respect towards patients at the end of life. P romote education in the field of palliative medicine and palliative care P revent unnecessary and futile interventions in order to allow a peaceful and dignified death. R educes unnecessary hospital admissions and the use of health services ..

Addressing suffering involves taking care of issues beyond physical symptoms. Palliative care uses a team approach to support patients and their caregivers. This includes addressing practical needs and providing bereavement counseling. It offers a support system to help patients live as actively as possible until death..

Timing of palliative care. Palliative care should ideally begin at the time of diagnosis of a life threatening condition and should continue through treatment until death and into the family’s bereavement..

What is end of life care?. End of life care is an important part of palliative care for people who are nearing the end of life. End of life care is for people who are considered to be in the last year of life, but this timeframe can be difficult to predict..

Appropriately engaging palliative care providers as a part of patient care improves overall symptom control, quality of life, and family satisfaction of care while reducing overall healthcare costs..

Who provides palliative care?. The professionals who provide this care fall into two main groups: 1. General care Those who give day-to-day care to patients with advanced illness and their family and friends, such as your GP, community nurses . 2. Specialist care Experts in palliative care, such as consultants in palliative medicine or clinical nurse specialists..

G eneral palliative care. Providing general palliative care is part of many health and social care professionals’ jobs. You might see these people regularly as part of your clinical treatment: your GP community nurses social workers care workers spiritual care professionals.

The aim of general palliative care is to provide : information for the patient and their family or friends, and signposting to other services accurate and all-round assessment of all needs coordination of career teams in and out of hours basic levels of symptom and pain control psychological, social, spiritual and practical support good communication with the patient and their family or friends and the professionals supporting them..

Specialist palliative care. Specialist palliative care services manage more complex patient care problems that cannot be dealt with by generalist services. Specialists usually work in teams to offer joined-up care and you might see one or more specialists when referred. Specialist teams include : doctors and nurses counselors specialist allied health professionals, such as physiotherapists, occupational therapists, dieticians and social workers . inpatient and outpatient facilities and bereavement support services for relatives of patients..

Issues addressed in palliative care. Physical Emotional and coping Practical Spiritual.

Physical. Physical symptoms such as pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia can be relieved with medicines or by using other methods, such as nutrition therapy, physical therapy, or deep breathing techniques.

Key Components of Palliative Care. Recognizing symptoms such as pain, nausea, fatigue, breathing or swallowing difficulties, constipation, and hopelessness. Identifying the patient's goals and development of a palliative care plan, specially for the patient. Understanding that many patients and their families struggle to make decisions. Assisting with advanced care directives to help people formulate and communicate their preferences regarding care during future incapacity..

Models of Palliative Care. Hospice Care Palliative Care Programs Outpatient Palliative Care Programs Community Palliative Care Programs or service..

Hospice Care. A well-established program to provide patients with a prognosis of six months or less. As delineated within the Medicare Hospice Benefit, these services can be provided in the home, nursing home, residential facility, or on an inpatient unit.

Outpatient Palliative Care Programs. Occur in ambulatory care settings to provide continuity of care for patients with serious or life-threatening illnesses..

Domains of Quality Palliative Care. • Domain 1: Structure and Processes of Care • Domain 2: Physical Aspects of Care • Domain 3: Psychological and Psychiatric Aspects of Care • Domain 4: Social Aspects of Care • Domain 5: Spiritual, Religious and Existential Aspects of Care • Domain 6: Cultural Aspects of Care • Domain 7: Care of the Imminently Dying Patient • Domain 8: Ethical and Legal Aspects of Care.

Structure and Processes of Care. Interdisciplinary team assessment based on patient/family goals of care; prognosis; disposition (level of care – inpatient unit, home); safety.

Social Aspects of Care. family/friend communication/interaction/support; caregiver crisis..

Ethical & Legal Aspects of Care. decision maker; advance directives.

PRINCIPLES OF PALLIATIVE CARE MANAGEMENT to provide effective palliative care..

Aims. To prepare the deceased for the mortuary (a funeral home or morgue), respecting their cultural beliefs To comply with legislation, in particular where the death of a patient requires the involvement of a Procurator Fiscal aka. Coroner To minimize any risk of cross-infection to relative, health care worker or persons who may need to handle the deceased..

Procedure. DR to be informed to declare death. Then Nursing supervisor , PRO and relatives must be notified as well. Removal of any accessories and devices { cath , iv lines, ports, tubes. Wounds , including pressure sores , should be covered with a waterproof dressing . Tube insertion points should be padded with gauze and tape to avoid purging . The body is then washed and dried. The body is dressed in a simple garment or wrapped in a shroud . patient identification Death certificate though they can vary according to an institution's preferred practices..

Common myths about palliative care. Palliative care is often misunderstood and some people believe things about it that aren’t true . MYTH : If I need palliative care it means I’ll have to go to a hospice You can receive palliative care in a range of settings including in your home, in hospital, in a care home or a hospice and can be offered by the NHS . MYTH : If I have palliative care it means my doctors have given up and I’ll no longer receive active treatment for my illness You can receive palliative care alongside active treatments for your illness, such as chemotherapy and radiotherapy..

Common myths about palliative care. MYTH: If I have palliative care I’ll no longer be seen by other specialists who know about my particular disease You can receive support alongside treatment from the clinicians who have been treating your particular illness . MYTH : Palliative care is just about treating pain and other physical symptoms It aims to give a holistic approach to give you the best quality of life possible. This means caring for all your physical, emotional, psychological, social and other needs . MYTH: Only people who are ill or dying can benefit from palliative care Palliative care teams are very aware that caring for someone with an advanced illness can have a big impact on family members and friends. They do what they can to help people cope..

conclusion. The end of a person's life is always going to be difficult for them and their families. However, with the right planning, care and support, death can be made easier on all involved. Palliative care is delivered by a range of healthcare professionals and provides this type of support. Palliative care can be delivered at any stage of illness alongside other treatments with curative or life-prolonging intent and is not restricted to people receiving end of life care..

R eferences. World Health Organization. Strengthening of palliative care as a component of comprehensive care throughout the life course. [cited 2016 April 09]. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R19-en.pdf . World Health Organization. WHO definition of palliative care. [cited 2016 April 09]. Available from: http://www.who.int/cancer/palliative/definition/en / . Oman Medical Journal Palliative Care: Time for Action/ 10 April 2016 Available from : https :// www.omjournal.org/articleDetails.aspx?coType=1&aId=754..

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