PALLIMED

Learning objectives

After completing this module you should have:

1 . Understanding of the role of palliative care in caring for the terminally ill

2 . Increased knowledge and confidence in handling common distressing symptoms

3 . Appreciation of the psychosocial factors that are important in palliative care

Introduction

Palliative care is profoundly valued by patients and their families and is at the very heart of primary care. Some even go so far as to suggest that if a practice cannot deliver good quality palliative care it is likely that it will have difficulty delivering other core services.

The aims of this module are to focus on some common problems which threaten the delivery of good quality palliative care in the community. Keri Thomas, the National Lead for the Gold Standards Framework (GSF), calls such difficulties "tripwires in palliative care" (Thomas, 2003).

These tripwires include management of:

·         pain

·         nausea and vomiting

·         breathlessness

·         spinal cord compression (SCC)

·         hypercalcaemia

·         delivery of medication by syringe driver

·         the last days of life

The World Health Organization (WHO) defines palliative care as "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" (WHO definition of palliative care).

In addition, palliative care:

·         provides relief from pain and other distressing symptoms

·         affirms life and regards dying as a normal process

·         intends neither to hasten nor postpone death

·         integrates the psychological and spiritual aspects of patient care

·         offers a support system to help patients live as actively as possible until death

·         offers a support system to help the family cope during the patient’s illness and in their own bereavement

·         uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated

·         will enhance quality of life, and may also positively influence the course of illness

·         is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications

Specialist palliative care services are needed by a significant minority of people whose deaths are anticipated, and may be provided:

·         directly - through the specialist palliative care services (see National Council for Palliative Care: Palliative care explained), or

·         indirectly - through advice to a patient’s professional advisers or carers

Hospice care refers to a philosophy of care rather than a specific building or service and may encompass a programme of care and array of skills deliverable in a wide range of settings. Palliative care teams comprising nurses and/or doctors are increasingly to be found in hospitals and offer an advisory service. Most hospices have a telephone advice service, which health professionals from hospitals and the community can use to obtain advice, frequently available 24 hours a day.

It is important for patients and families to be aware that palliative care is not only about end of life - a significant number of patients may benefit from a palliative care approach for months or even years before death. Terminal care is an important and distinct part of palliative care and usually refers to the management of patients during their last few days or weeks of life from a point at which it becomes clear that the patient is in a progressive state of decline.