___________________________________________ Palliative Care and Pain Management at the End of Life
To specifically address the needs of patients’ families, the American College of Critical Care Medicine and the Society of Critical Care Medicine (SCCM) have developed guidelines for family-centered care in the ICU. The SCCM guidelines followed a rigorous, evidence-based analysis representing the state of international science in family-centered care and family support for critically ill neonatal, pediatric, and adult ICU patients [525]. The perspectives of patients and family members were incorporated through initial literature review, followed by direct consultation. In support of family-centered care, guidelines recommend endorsement of a shared decision- making model, interdisciplinary family care conferencing to reduce family stress and improve consistency in communica- tion, culturally appropriate requests for truth-telling and informed refusal be honored, spiritual support from an adviser or chaplain, including family members in staff rounds and dur- ing resuscitation efforts, open flexible visitation, and family support before, during, and after a patient’s death [525]. Other considerations include assigning family navigators to improve communication throughout the ICU stay, and proactive pal- liative care consultation to decrease ICU and hospital stay. Following the initial emphasis on family-centered care in the ICU setting, the use of palliative care consultation increased 113% in one study, and from 5% to 21% in another study [24; 526]. Another model that integrates palliative care into the ICU improved the quality of care and led to a higher rate of formalization of advance directives, better utilization of hospice, and a decreased use of nonbeneficial life-prolonging treatments [515]. CONCLUSION As a result of ongoing advances in medicine, the trajectory of illness for many diseases has shifted, yielding an increasing number of patients needing palliative care throughout the continuum of care and, especially, at the end of life. High- quality palliative care focuses on the physical, psychosocial, and spiritual well-being of the patient as well as the family. Care is provided by a palliative healthcare team comprised of members who have expertise in communication, pharma- cologic principles of pain management, and identification of associated psychosocial and spiritual needs. Palliative care eases the burden of suffering experienced by patients approaching life’s end and provides for grief counseling and bereavement services for a family adjusting to loss. Physicians and other healthcare professionals should strive to enhance their knowl- edge of key strategies to achieve high-quality palliative care, as detailed in this course.
Implicit Bias in Health Care The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, profes- sionals’ attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients’ trust and comfort with their provider, leading to earlier termina- tion of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health profes- sionals’ implicit biases can further exacerbate these existing disadvantages. Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control- based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual’s behaviors. These strategies include increas- ing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.
WORKS CITED https://qr2.mobi/pallative-care
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MDCA1525
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