Palliative care

Question 1

What is palliative care?

Answer 1

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Question 2

What is generalist palliative care?

Answer 2

It is palliative care provided for those affected by life- limiting illness as an integral part of standard clinical practice by any healthcare professional providing usual care.
It is provided in the community by general practice teams, allied health teams, district nurses, residential care staff, community support services and community paediatric teams.
It should be provided in hospitals by general adult and paediatric medical and surgical teams, as well as disease specific teams for instance oncology, respiratory, renal, intensive care and cardiac teams.

Question 3

What is specialist palliative care?

Answer 3

Is palliative care provided by those who have undergone specific training or accreditation in palliative care or medicine working in the context of a multidisciplinary team of palliative care health professionals.
Specialist palliative care practice builds on the palliative care provided by generalist providers and reflects a higher level of expertise in complex symptom management and spiritual, psychosocial, cultural, and grief and loss support.
Specialist palliative care provision works by: a) Providing direct care b) Advising other carers

Question 4

What are the causes of xerostomia? and what problems do xerostomia cause?

Answer 4

Causes:
 Tumour
 Radiotherapy
 Drugs: Morphine, Anticholinergics, Antipsychotics, Anxiolytics
Problems:
 Increases risk of plaque-related diseases and tooth decay
 A dry mouth is more acidic, more conducive to bacterial overgrowth
 Dry, cracked lips  Angular cheilitis  Problems wearing dentures  Difficulty with eating, swallowing, communication

Question 5

What can relieve xerostomia?

Answer 5

 Treat underlying cause where possible  Good oral care  Frequent sips of water  Ice chips
 Pineapple  Effervescent vitamin C  Saliva substitutes
 Chewing gum

Question 6

What can be done for a sore mouth?

Answer 6

 Treat underlying cause if possible  Eg GCSF for chemotherapy induced mucositis
 Good oral care
 Bland foods
 Local measures  Gelclair – mechanical barrier
 Difflam spray – local anaesthetic  MuGard oral rinse - mucoadhesive  Bonjela  Soluble aspirin  Oramorph as a topical analgesic

Question 7

What’s the WHO analgesic ladder?

Answer 7

1. Non-opiod, adjuvant. eg paracetamol, aspirin or an NSAID
2. Opioid for mild to moderate pain +- non-opioid, +- adjuvant. eg. codeine
3. Opioid for moderate to severe pain +- non-opiod +- adjuvant. eg. morphine, oxycodone, fentanyl.

Question 8

What is drooling?

Answer 8

 Particularly in neurological conditions  Motor neurone disease
 Head and neck cancer  Parkinson’s disease  Patients with brain tumours  Cerebral palsy  Stroke
 Either overproduction of saliva or
 Inability to swallow normal amounts of saliva
Management  Positioning  Skin protection  Suction
 Drugs to dry secretions  Hyoscine butylbromide  Glycopyrrhonium
 Radiotherapy - rarely

Question 9

What is osteonecrosis of the jaw?

Answer 9

 Associated with bisphosphonates, multiple myeloma, bony metastatic disease
 60% dental surgical procedure  May be due to over suppression of bone turnover
 Pain, swelling  Loosening of teeth  Exposed bone  Numbness or heaviness of jaw  May be asymptomatic
Prevention  Elimination all sites of potential infection before treatment  Avoidance invasive dental procedures during treatment  Conservative treatment:
 Pain control  Debridement of necrotic bone  Treatment of infection  Stop bisphosphonates