What is palliative care?

Palliative care is a special type of medical care for people with serious illness.

This type of care is focused on providing relief from the symptoms and stress of a serious illness.

Palliative care is provided along with medical treatment.

What are the goals of palliative care?

  • To help people with serious illnesses feel better. 
  • It prevents or treats symptoms and side effects of disease and treatment. 
  • Palliative care also treats emotional, social, practical, and spiritual problems that occur from the medical illness 
  • Palliative care improves quality of life.

How should palliative care be incorporated into treatment care?

This is done through a multi-disciplinary team approach.

While receiving palliative care, people can remain under the care of their Doctor and still receive treatment for their illness.

Here is a summary of the latest Guidelines for Quality Palliative Care:

The 4th edition of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care (NCP Guidelines) was published with the goal of improving access to quality palliative care for all people with serious illness regardless of setting, diagnosis, prognosis, or age.

There are 8 domains of care:

Domain 1: Structure and processes of care

Palliative care principles and practices can be integrated into any healthcare setting, delivered by all clinicians, and supported by palliative care specialists who are part of an interdisciplinary team (IDT) with the professional qualifications, education, training, and support needed to deliver optimal patient- and family-centered care.

Palliative care begins with a comprehensive assessment and emphasizes patient and family engagement, communication, care coordination, and continuity of care across healthcare settings.

Domain 2: Physical aspects of care

Physical care of seriously ill patients begins with an understanding of the patient goals in the context of their physical, functional, emotional, and spiritual well-being. The assessment and care plan focus on relieving symptoms and improving or maintaining functional status and quality of life.

The management of symptoms encompasses pharmacological, nonpharmacological, interventional, behavioral, and complementary treatments.

Physical care, acute and chronic symptom management across all care settings, is accomplished through communication, collaboration, and coordination between all professionals involved in the patients’ care, including primary and specialty care providers.

Domain 3: Psychological and psychiatric aspects of care

The palliative care IDT systematically addresses psychological and psychiatric aspects of care in the context of serious illness. IDTs conduct comprehensive developmentally and culturally sensitive mental status screenings of seriously ill patients. The social worker facilitates mental health assessment and treatment in all care settings, either directly, in consultation, or through referral to specialist level psychological and/or psychiatric care.

The IDT communicates to the patient and family the implications of psychological and psychiatric aspects of care in establishing goals of care and developing a treatment plan, addressing family conflict, delivering grief support and resources from the point of diagnosis onward, and providing referrals for patients or family members who require additional support.

Domain 4: Social aspects of care

Social determinants of health, hereafter encompassed in the term “social factors,” have a strong and sometimes overriding influence on patients with a serious illness. Palliative care addresses environmental and social factors that affect patient and family functioning and quality of life.

The palliative care IDT partners with the patient and family to identify and support their strengths and to address areas of need. The IDT includes a professional social worker to maximize patient functional capacity and achieve patient and family goals.

Domain 5: Spiritual, religious, and existential aspects of care

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Spirituality is recognized as a fundamental aspect of compassionate, patient- and family-centered palliative care. It is a dynamic and intrinsic aspect of humanity, through which individuals seek meaning, purpose, and transcendence and experience relationship to self, family, others, community, society, and the significant or sacred.

Spirituality is expressed through beliefs, values, traditions, and practices. The palliative care IDT serves each patient and family in a manner that respects their spiritual beliefs and practices and is also respectful when patients and families decline to discuss their beliefs or accept spiritual support.

Domain 6: Cultural aspects of care

Assessing and respecting values, beliefs, and traditions related to health, illness, family caregiver roles, and decision-making are the first step in providing culturally sensitive palliative care. Palliative care IDT members continually expand awareness of their own biases and perceptions about race, ethnicity, gender identity and gender expression, sexual orientation, immigration and refugee status, social class, religion, spirituality, physical appearance, and abilities.

Information gathered through a comprehensive assessment is used to develop a care plan that incorporates culturally sensitive resources and strategies to meet the needs of patients and family members. Respectful acknowledgment of and culturally sensitive support for patient and family grieving practices are provided.

Domain 7: Care of the patient nearing the end of life

This domain highlights the care provided to the patient and their family near the end of life, with a particular emphasis on the days leading up to and just after the death of the patient. The meticulous and comprehensive assessment and management of pain and other physical symptoms, as well as social, spiritual, psychological, and cultural aspects of care, are critically important as the patient nears death.

It is essential that the IDT ensures reliable access and attention in the days before death and provides developmentally appropriate education to the patient, family, and/or other caregivers about what to expect near death, as well as immediately following the patient’s death.

The interdisciplinary model of hospice care is recognized conceptually and philosophically as the best care for patients nearing the end of life. Discussion regarding hospice as an option for support should be introduced early so that patients and families can understand eligibility and the benefits and limitations of accessing this care model.

Early access to hospice support should be facilitated whenever possible to optimize care outcomes for the patient and the family. Palliative care teams, hospice providers, and other healthcare organizations must work together to find innovative, sustainable supportive care solutions for all patients and families in their final months of life.

Domain 8: Ethical and legal aspects of care

The palliative care IDT applies ethical principles to the care of patients with serious illness, including honoring patient preferences as well as decisions made by legal proxies or surrogate decision makers. It is important to note that in all cases, surrogates’ obligations are to represent the patient’s preferences or best interests.

Familiarity with local and state laws is needed relating to advance care planning, decisions regarding life-sustaining treatments, and evolving treatments with legal ramifications (e.g., medical marijuana), especially when caring for vulnerable populations, such as minors, prisoners, or those with developmental disability or psychiatric illness.

 

In summary; The study discussed palliative care as inclusive of all people with serious illness, regardless of setting, diagnosis, prognosis, or age. Second, the timely consideration of palliative care by health providers is discussed.

The full guideline can be assessed from links in the reference section.

Reference: Betty R. Ferrell, Martha L. Twaddle, Amy Melnick, and Diane E. Meier.Journal of Palliative Medicine.http://doi.org/10.1089/jpm.2018.0431 https://www.liebertpub.com/doi/abs/10.1089/jpm.2018.0431?journalCode=jpm&

 

Article compiled by Dr. Ngozi Onuoha, MD, MBA-HCM

Photo by rawpixel on Unsplash

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