What is palliative care?
The eight domains of palliative care to meet the needs of the whole person are structure and process of care; physical aspects of care; psychological and psychiatric aspects of care; social, spiritual, religious, and existential aspects of care; care of the patient near EOL; and ethical and legal aspects of care. 5 When providing palliative care, healthcare professionals should consider the population of the person for whom they are caring to provide the best and most appropriate care Different populations may include adult, pediatric, neonatal, perinatal, and geriatric patients. Besides physical needs, other issues faced by seriously ill patients may include the following 6 : • Losing independence • Maintaining self-determination and a sense of control • Decision making about how and where to die • Declining functions and related concerns about being a burden • Fear of pain and other distressing symptoms BEFORE MOVING ONTO THE NEXT SECTION, PLEASE COMPLETE CASE STUDY 1.
Introduction
Palliative care is the treatment of the discomfort, symptoms, and stress associated with advanced or life-limiting illness. 3 The emphasis of palliative care, which occurs across the patient’s illness trajectory, is on (1) encouraging conversations about goals of care at time of patient diagnosis of a serious illness; (2) considering the benefits versus burdens of treatment options; and (3) attending to the physical, psychological, social, spiritual, and existential needs of the patient/family unit across the lifespan. Patients receiving palliative care often suffer from the symptoms and stress of serious illnesses, including but not limited to cancer, dementia, heart failure, Parkinson’s disease, and chronic obstructive pulmonary disease. 4 Palliative care teams offer this care to support curative or other treatment plans of care and help patients and families understand their choices for medical treatment. 2 Palliative care is not dependent on prognosis and patients do not need to be in hospice or at end of life (EOL); patients can receive palliative care at any age and at any time during their illness. 3
Palliative care likely originated in Roman times, as members of the community wore a protective cloak named “pallium.” Today, palliative care is defined as the protection from and prevention of suffering via identification, assessment, and treatment of physical, psychosocial, and spiritual problems. 1 Palliative care is the overarching, supportive approach that helps seriously ill patients and families address problems and improve their quality of life. 2 Hospice is a type of palliative care, specifically for those that have a terminal disease and life-limiting prognosis. Hospice and palliative care can improve a patient’s quality of life by • providing relief from pain and other distressing symptoms such as nausea and fatigue; • integrating emotional, psychological, and spiritual aspects of patient care; • offering a support system to enhance quality of life; and • offering bereavement and grief counseling to help the family cope during the patient’s illness and after death.
Case Study 1 Instructions: Please read through the case study below and consider the questions that follow.
You are seeing a new patient in the office, Ms. Johnson, as her previous primary physician has recently retired. Ms. Johnson is 80 years old and has a history of well-controlled hypertension and hypercholesterolemia, as well chronic obstructive pulmonary disease (COPD). Despite progressively worsening pulmonary disease and multiple attempts at quitting, Ms. Johnson continues to smoke cigarettes, but she has cut down from 1 pack to a half pack per day. In addition to her pulmonary inhalers, she uses home oxygen at 2 L per minute on an as-needed basis. Ms. Johnson’s son, Raymond, reports that her activities of daily living are now noticeably limited by shortness of breath. He asks if there are any services that could provide additional support to his mother. You suggest that it may be a good time to consider palliative care services. Ronald is quite surprised by the suggestion and becomes concerned that you are “giving up” on his mother, probably because she is still smoking. You go on to explain the emphasis of palliative care is supportive, that it may continue for an extended period of time, and that it is not the same as hospice care. 1. All of the following describe palliative care programs EXCEPT a. the patient must have a life expectancy less than 6 months. b. risks, benefits, and goals are considered when considering treatment options. c. palliative care is intended to limit and prevent suffering. d. families may also participate in the program. Explanation: Palliative care may be utilized for extended periods of time in treating advanced illnesses. Hospice care, which is a subset of palliative care, is typically utilized during the last months of life, and requires a life expectancy less than 6 months. 2. Based on the provided information, palliative care is MOST APPROPRIATE for which patient in the following list? a. A 32-year-old female diagnosed with pre-diabetes b. A 72-year-old male with a diagnosis of dementia
c. A 75-year-old female who recently underwent knee replacement surgery d. A 65-year-old male with recent resection of a superficial basal cell carcinoma
Explanation: The patient with dementia has a diagnosis of a disorder that is chronic and progressive. He and his family are most likely to benefit from palliative care at this time. Pre-diabetes may be reversed with lifestyle changes, and it is not necessarily a progressive and chronic disorder.
34
Powered by FlippingBook