Palliative care

Palliative Care: A Comprehensive Approach to Quality of Life

Imagine facing a serious illness that challenges your body, mind, and spirit. How would you want to spend your remaining days? Palliative care offers a holistic approach to managing the complexities of such illnesses, focusing on improving quality of life rather than just treating symptoms.

The Essence of Palliative Care

At its core, palliative care is an interdisciplinary team effort that addresses physical, psychosocial, and spiritual needs. It’s not just about managing pain; it’s about providing comfort and support to those who are facing serious illnesses.

Interdisciplinary Teams

Palliative care teams consist of various professionals such as physicians, nurses, therapists, psychologists, social workers, chaplains, and dietitians. These experts work together to ensure that all aspects of a patient’s well-being are addressed.

Providing Palliative Care

Palliative care can be provided in various settings, including hospitals, outpatient clinics, skilled nursing facilities, and homes. It is designed to complement curative treatments and can be initiated at any stage of illness, not just near the end.

Benefits of Palliative Care

Evidence shows that palliative care improves physical and emotional relief, strengthens patient-physician communication, and ensures coordinated continuity of care. It’s a vital service for millions worldwide, yet access remains a significant challenge in many regions.

Comparing Palliative Care with Hospice

In the United States, hospice care differs from palliative care. While hospice focuses on comfort and psychological support, it often involves curative therapies not pursued. Outside the US, hospice usually refers to a specialized institution for end-of-life care.

Statistics and Trends

In 2016, there was a movement to extend concurrent care to adults eligible for hospice but not yet ready to forego curative treatments. Over 40% of dying patients in the US undergo hospice care, with most receiving excellent care at home.

Total Pain and Symptom Management

The concept of total pain considers physical, psychological, social, and spiritual aspects. Identifying the cause guides care and significantly impacts quality of life. Physical pain is managed using medications, while radiation may be used for cancer patients.

Mental and Emotional Support

Psychosocial pain and anxiety require compassionate caregiving, psychosocial assessments, and open discussions about adjustment, coping, support, relationships, meaning, and control. Spirituality is a fundamental aspect of palliative care, with chaplains often available in hospice facilities.

Addressing Specific Symptoms

Nausea and vomiting are common symptoms in advanced terminal illnesses, and various antiemetic options can alleviate these distressing symptoms. Haloperidol and droperidol may be prescribed for terminally ill patients experiencing nausea and vomiting.

Medically Assisted Food and Drink

Medicinally assisted food and drink are common practices to prolong life and improve quality of life for terminally ill people. The Edmonton Symptom Assessment Scale (ESAS) is used to assess symptoms such as pain, activity, nausea, depression, anxiety, and others.

Pediatric Palliative Care

Children with serious illnesses also benefit from palliative care. Pain perception in premature and neonatal infants is equal to that of adults, and behavioral responses must be considered when evaluating children’s symptoms.

Treatment Options for Children

Treatment options include pharmacologic and non-pharmacologic modalities such as hot and cold packs, massage, play therapy, and distraction therapy. Respite care can aid in alleviating physical and mental pain from the child and their family by allowing caregivers to rest and renew themselves.

Geriatric Palliative Care

With aging populations putting pressure on resources, geriatric palliative care has emerged as a necessary approach. Long-term care focuses on increasing patients’ quality of life through prevention, relief, and addressing pain and psychosocial problems.

Certification and Training

In the US, physician sub-specialty of hospice and palliative medicine was established in 2006 to provide expertise in care of people with life-limiting disease. In the UK, Palliative Medicine specialist training is delivered alongside Internal Medicine stage two training over four years.

Support for Caregivers

Caregivers are crucial to palliative care systems and may find themselves under severe emotional and physical strain. Opportunities for caregiver respite are provided by hospices, ensuring that caregivers can rest and renew themselves.

Board Certification

In the US, board certification for physicians in hospice and palliative medicine is done through American Board of Hospice and Palliative Medicine or any specialty board approved procedure. Regional variation exists, with different payment systems and locations offering services.

The Future of Palliative Care

While progress has been made, many countries have not recognized palliative care as a public health problem. Gaps in care for people with severe mental illness (SMI) and chronic pain patients remain, highlighting the need for more comprehensive approaches.

Research and Recommendations

Research funded by the UK’s National Institute for Health and Care Research has addressed these areas of need, offering recommendations to improve access and quality. Other studies suggest that easier access to electronic patient records could help people manage their symptoms at home.

A Holistic Approach

The focus on quality of life in palliative care has increased since the 1990s, with many hospitals offering programs and nearly one-fifth of community hospitals having them. However, physicians practicing palliative care often face lack of support from patients’ families, healthcare professionals, and social peers.

Conclusion

Palliative care is a vital service that addresses the complex needs of individuals facing serious illnesses. It’s about more than just managing symptoms; it’s about providing comfort, support, and dignity to those who need it most. As we continue to evolve in our understanding and delivery of palliative care, let us strive to ensure that everyone has access to this essential service.