Dr. Francis SANWO

WHO Definition of 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. These problems are:            

Physical problems. These include: pain, insomnia, shortness of breath and loss of appetite. Pain treatment is a key part of hospice and palliative care as it is one of the most common and distressing symptoms that people with serious illness and at the end of life face.Other treatments include nutritional guidance, physical therapy and occupational therapy.

Emotional, social, and coping problems. Patients and their families face stress during illness that can lead to fear, anxiety, hopelessness, or depression. Family members may take on care giving, even if they also have jobs and other duties. Treatments may include: Counseling, support groups, family meetings and referrals to mental health providers

Practical problems. Some of the problems brought on by illness are practical, such as money- or job-related problems, insurance questions, and legal issues.

Spiritual issues. When people are challenged by illness, they may look for meaning or question their faith. A palliative care team may help patients and families explore their beliefs and values so they can move toward acceptance and peace.                          

 

Palliative care: affirms life and regards dying as a normal process; intends neither to hasten or postpone death;  offers a support system to help patients feels better and live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; will enhance quality of life, and may also positively influence the course of illness.

It is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications. It prevents or treats symptoms and side effects of disease and treatment. Palliative care can be given at the same time as treatments meant to cure or treat the disease. Palliative care may be given when the illness is diagnosed, throughout treatment, during follow-up, and at the end of life.

Palliative care may be offered for people with illnesses, such as: cancer, heart disease, lung diseases, kidney failure, dementia and HIV/AIDS. While receiving palliative care, people can remain under the care of their regular health care provider and still receive treatment for their disease.

Who Gives Palliative Care?

Any health care provider can give palliative care. But some providers specialize in it. Palliative care may be given by: a team of doctors, nurses and nurse practitioners, physician assistants, dietitians, social workers and psychologists. Others may include family members, community carers and religious leaders.

 Palliative care may be offered by hospitals, home care agencies, cancer centers, and long-term care facilities. .

 Attitudes and principles required for successful palliative care.

A caring attitude involves sensitivity, empathy and compassion, and demonstrates concern for the individual. There is concern for all aspects of a patient’s suffering, not just the medical, nursing or social work problems. There is also a non-judgmental approach in which personality, intellect, ethnic origin, religious belief or any other individual factors do not prejudice the delivery of optimal care

Consideration of individuality. The practice of categorizing patients by their underlying disease, based on the similarity of the medical problems encountered, fails to recognize the psychosocial features and problems that make every patient a unique individual

These unique characteristics can greatly influence suffering and need to be taken into account when planning the palliative care for individual patients

Cultural Considerations. Ethnic, racial, religious and other cultural factors may have a profound effect on a patient’s suffering. Cultural differences are to be respected and treatment planned in a culturally sensitive manner

Consent. The consent of a patient, or those to whom the responsibility is delegated, is necessary before any treatment is given or withdrawn. The majority of patients want shared decision making although physicians tend to underestimate this. Having assessed what treatment is appropriate or inappropriate, this is discussed with the patient.

Choice of place of care. The patient and family need to be included in any discussion about the place of care. Patients with a terminal illness should be managed at home whenever possible though in the developed world few do so, most dying in hospitals.

Communication. Good communication between all the health care professionals involved in a patient’s care is essential and is fundamental to many aspects of palliative care. Good communication with patients and families is also essential.

Clinical context: Appropriate treatment. All palliative treatment should be appropriate to the stage of the patient’s disease and the prognosis. Over-enthusiastic investigations, therapy that is inappropriate and patient neglect are equally deplorable.

The prescription of appropriate treatment is particularly important in palliative care because of the unnecessary additional suffering that may be caused by inappropriately active therapy or by lack of treatment. Treatment known to be futile, given because ‘you have to do something’, is unethical. Where only symptomatic and supportive palliative measures are employed, all efforts are directed at the relief of suffering and the quality of life, and not necessarily at the prolongation of life.

Care Excellence. Palliative care should deliver the best possible medical, nursing and allied health care that is available and appropriate.

Consistent Medical Care. Consistent medical management requires that an overall plan of care be established, and regularly reviewed, for each patient. This will reduce the likelihood of sudden or unexpected alterations, which can be distressing for the patient and family.

Coordinated Care involves the effective organization of the work of the members of the inter-professional team, to provide maximal support and care to the patient and family.

Continuity of Care. The provision of continuous symptomatic and supportive care from the time the patient is first referred until death is basic to the aims of palliative care. Problems most frequently arise when patients are moved from one place of care to another.

Crisis Prevention. Good palliative care involves careful planning to prevent the physical and emotional crises that occur with progressive disease. Many of the clinical problems can be anticipated and some can be prevented by appropriate management. Patients and their families should be forewarned of likely problems, and contingency plans made to minimize physical and emotional distress.

Caregiver Support. The relatives of patients with advanced disease are subject to considerable emotional and physical distress, especially if the patient is being managed at home. Particular attention must be paid to their needs as the success or failure of palliative care may depend on the caregivers’ ability to cope. Palliative care, whether at home or in a hospital, often succeeds or fails depending on the care and support provided for the caring relatives.

Continued Reassessment is a necessity for all patients with advanced disease for whom increasing and new clinical problems are to be expected.

Communication with Patients.

Important and potentially difficult discussions are frequently necessary with palliative care patients who have active, progressive, far-advanced disease, regarding breaking bad news, further treatment directed at the underlying disease and communicating prognoses among others.

Decisions must be individualized for each patient and should be made in discussion with the patient and family.

 The Difference Between Palliative Care and Hospice.

Improving quality of life and relieving suffering is the key goal of hospice and palliative care. But palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness. Hospice care is most often offered only when the person is expected to live 6 months or less.

People should be able to access hospice and palliative care as soon as they are diagnosed with a life-limiting condition, and not just at the end of life. Ensuring that people are living with conditions in comfort and without distress is as important as ensuring a good death. Hospice and palliative care is provided wherever the person is, whether that is in the home, hospital, community clinic or hospice.