Palliative Care

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Palliative Care

• Robyn Millership
• Nurse Consultant Palliative Care

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What is Palliative Care ?

• the active total care of people whose illness
  is not responsive to curative treatment.
• Care is delivered by coordinated medical,
  nursing and allied health professionals which is
  provided, where possible, in the environment of
  the persons choice .
• Control of pain, of other symptoms and provision
  of psychological, social, emotional and spiritual
  support is paramount.

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What Is Palliative Care ? (2)

• Not just patients with cancer
• 80 hospice pts have primary diagnosis of
  cancer
• Includes pain and other symptom control as well
  as social, psychological and spiritual care.
• The goal is to achieve the best possible quality
  of life.

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Core Values of Palliative Care

• The dignity of the patient and their family
• Compassionate care of the patient and family
• Equity in access to palliative care services
• Empowerment of the patient, family caregiver to
  manage their own situation
• Respect for the patient, family and carers
• Advocacy on behalf of the expressed wishes of
  patients and family.
• Pursuit of excellence in the provision of care
  and support

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Palliative Care

• Affirms life and regards dying as a normal
  process
• Neither hastens nor postpones death
• Provides relief from pain and other distressing
  symptoms
• Integrates the psychological and spiritual
  aspects of care
• Offers a support system to patients and families

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Palliative Care Is Not Just About Death and Dying

• Palliative Care Is About Life and Living

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Where is it delivered ?

• The triangle of care is the basic model
• Home (community services)
• Hospitals (consultative services)
• Hospice
• Model is expanding
• Day hospice model evolving
• Outpatient clinics
• Acute subacute beds
• Role of greater collaboration with acute care
  units

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When is Palliative Care needed ?
The disease or illness is considered to be
incurable. The disease recurs. The disease is
increasingly unresponsive to treatment. For
symptom assessment and /or control at any stage
of the illness For carer support in the setting
of progressive illness. Often, the point at
which the decision is made is variable and
uncertain, and influenced by the needs of patient
and family.
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Who needs palliative care ?
Patients who have symptoms associated with the
disease or treatment regardless of the
prognosis. Patients who wish to die at
home. Patients who require in-patient terminal
care. Carers who required support or symptom
control in the home setting.
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How is palliative care provided ?
By assessing and addressing Physical
symptoms Social networks and support Spiritua
l preferences Psychological responses Cultura
l needs
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Physical domain

• Assessment
• Goal centred care
• Symptom management, including pain, nausea,
  vomiting, constipation etc etc
• Assistance with activities of daily living,
  including appropriate home aides

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Spiritual Domain

• the spiritual dimensions of the patient and
  family are acknowledged, explored and responded
  to appropriately.
• the religious beliefs of the patient and family
  are recognised and respected.
• appropriate spiritual and religious support for
  patients, families and care
• Palliative Care Australia
• Standards for Palliative Care Provision
• It is often necessary to hear the life story of a
  person to enable them to begin the transition to
  the next phase of life

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Psychological Domain

• Assessment and response to the psychological
  impact of the terminal illness
• Referral to a specialist for expert advice or
  when emotional needs cannot be met
• Availability of a bereavement program that is
  evidence and needs based
• Recognition of the impact of staff providing this
  type of care to patients and families
• Palliative care Australia
• Standards for palliative care

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Social domain

• Feeling of acceptance
• Practically arranging affairs
• Financial matters
• Family concerns

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Cultural domain

• Services meet the cultural needs of the patient
  and family and reflects the diversity of the
  community
• The staff mix resembles the community population

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Structural standards

• Care is interdisciplinary
• Specialist education in palliative care is
  provided
• Commitment to quality improvement

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Palliative Care Multidisciplinary
Teams(includes the patient and family)

• Art therapist
• Music therapist
• Massage therapist
• Reiki therapist
• Teaching centre (students)

• Nurses
• Doctors
• Social workers
• Pastoral care workers
• Clinical psychologists
• Psychiatrists
• Physiotherapists
• Occupational therapists
• Volunteers

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Reasons for Admission to Hospice

• Symptom management, including pain, nausea, etc
• Respite family and/or patient
• Often results in terminal care
• End-of-life care
• Limited Rehabilitation
• In-depth psycho-social assessment support

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Causes of Distress in End of Life Care

• Physical functioning difficult with mobility,
  sleep, appetite, eating, energy, fatigue
• Physical integrity nausea, pain, breathing, sore
  mouth, physical appearance, CONSTIPATION
• Emotional well-being mood disorders, anxiety,
  depression, fear of dying process, anger, outlook

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Causes of Distress in End of Life Care

• Social relationships ability to undertake
  leisure activities, social activities
• Illness adaptation coming to terms with illness,
  advancement
• Economic/occupational for family, funeral
• Cognitive ability difficulty with
  concentration/memory

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Focus of Care

• Assessment
• Symptom control
• Evaluation of care goals and objectives
• Spiritual and psychosocial care
• Communication and lots of it!

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Future Directions

• Incorporation of palliative care principles and
  practice into a broader range of settings
• Encourage introduction of palliative care to
  patients and families before the terminal phase
  of illness
• Encourage a parallel course of care rather than
  exhausting one and seeing palliative care as a
  last resort
• Promote awareness of palliative care for all
  health professionals