palliative care 1b Flashcards
The three forms of palliative
care
- Delivering a palliative approach to care that
promotes quality of life. - Providing specialist palliative care for complex
symptoms. - Providing end of life care.
Delivering a palliative
approach
Aims to promote quality of life for a person suffering from a life
limiting illness.
Does not attempt to prolong life or hasten death.
Recognises that the person is getting more frail.
Acknowledges that death is drawing near.
Realises that management of symptoms is needed to improve
comfort.
Delivering a palliative
approach consists of three
components
Identification of the needs of the client
Discussion about the client’s choices and options.
Collaboration with other health professionals and
services
When to apply a palliative
approach
Palliative care should be introduced gradually as
life-threatening diseases progress.
Types of life-limiting illnesses:
Cancer
Organ failure
Neurological conditions
When no cure is available and treatment is limited.
Moving from curative to palliative
The GP is in a good position to refer to palliative
care.
Physical conditions, like multiple admissions for
progressive disease is a good indication that
improved quality of life is becoming more of a goal
than cure.
Psychosocial considerations influence the change
to palliative care, e.g. the patient’s /family’s needs,
preference and understanding
Three questions can be asked
to view patients as being
appropriate for palliative care
- Is the patient on a ventilator or pressors initiated in the field or in the ED?
- Does the patient have a life-limiting illness (you wouldn’t be surprised if the patient died within 6 months)?
- Does the patient have functional disability due to an advanced life limiting illness
manifested by cachexia, progressive loss of ADLs leading to bed/chair bound
status or multiple trips to the ED or hospital the past 6 months? (Exclude chronic
disability like cerebral palsy patients)
Palliative care is not only about
people dying.
End of life care is a small part of palliative care.
Modern focus is on early referral to palliative
services.
The problem is that most people think that if they
are referred to palliative care it means they are
going to die soon.
Evidence has shown that the introduction of
palliative care improves the quality of life of a
patient and may even prolong life .
The three forms of palliative
care
- Delivering a palliative approach to care that
promotes quality of life. 2. Providing specialist palliative care for complex
symptoms. - Providing end of life care.
Providing specialist palliative
care for complex symptoms
This is the second form of palliative care.
The patient is exhibiting symptoms that are too
complex to be managed by community nurses,
GPs.
They are then referred to specialist palliative care
services, like a hospital, or a palliative care doctor
who may visit them at home.
End of life care
This occurs when the patient is obviously dying.
Prognosis is weeks rather than months.
Group A: Primary Care
This group will be the largest group.
They do not need specialist care services, as their
needs are being met through their own resources,
either their GP, or oncologists, geriatricians.
Approximately 2/3 of the identified population is in
this group.
Their prognosis can be months or years.
Group B: Intermediate
This group need intermittent consultation with
specialist palliative services as their symptoms cause
them distress.
These symptoms may be physical, social or
psychological.
They continue to receive care mainly from their
primary provider.
Their prognosis can be weeks to months
Group C : Complex
These patients have complex physical, emotional
and spiritual needs that are not being met by simple
protocols of care.
They need a complex plan of care involving
specialist care, while still working in conjunction with
the primary provider.
They are the smallest percentage of the groups.
Their prognosis is likely days to weeks.
Discussion: Quality of life
It is difficult to define because it is very individual.
It is dynamic: it changes all the time.
It is multidimensional: physical quality of life,
psychological quality of life, spiritual quality of life
5 important aspects of end-of life
care skills
Communication. Recognising dying. Negotiating goals of care. Act if things aren’t going well. Effective teamwork
