Palliative care refers to specialized medical care for ill people with illness that do not have a clear cure. A strong emphasis is placed on providing symptom and stress relief for both the patient and the surrounding people, such as friend and family.
Definition
The term comes from the Latin word, palliare, which translates to cloak. This is because the aim of treatment is not to provide a cure, but to mask the effects of the condition. This differs from most other types of health care, as the aim lies in the effective management of the condition and not a treatment to cure.
Palliative care is generally accepted to be healthcare that alleviates symptoms and is independent of whether a cure for the condition is available. Therefore, it is also useful to address side effects of other curative treatments, like the nausea associated with chemotherapy.
Often palliative care is associated with terminal diseases such as cancer. Whilst this case is one part of palliative care, it is not the only facet of the care and should not be thought of as limited to that.
It involves a multidisciplinary care team of doctors, nurses and other specialized health professionals that work together to provide cohesive support for patients who are suffering. It can be helpful for patients of any age and with various severities of conditions and can also be given alongside traditional curative treatment.
Approach
The focus of palliative care is to provide relief to patients with serious illnesses from:
- Symptoms
- Pain
- Physical Stress
- Psychological Stress
It is intended that this care will help to improve the quality of life, both for the patient and their family.
Symptom Assessment
Edmonton Symptoms Assessment Scale is a tool used to help classify the severity of different symptoms on a visual analog scale. This is usually completed by the patient, possibly with the help of a nurse or relative, and places each symptom on a scale from 0 to 10.
The symptoms assessed with this scale are:
- Pain
- Activity
- Nausea
- Depression
- Anxiety
- Drowsiness
- Appetite
- Well-being
Occasionally shortness of breath is also rated from 0 to 10, if the patient is experiencing symptoms of this.
Symptom Management
Often traditional medicines are used differently and for alternative indications when used in palliative care. Some examples of this are:
- Antipsychotic medications for nausea
- Anticonvulsant medications for pain
- Analgesics (morphine) for dyspnea
Additionally, the way the medications are administered is often different, due to the particular situation of the patient. For example, many patients receiving palliative care lose their ability to swallow and cannot, therefore, take oral medications easily. Instead, they may need subcutaneous administration, which bypasses the need to swallow but poses less difficulty than intravenous administration.
Stress Management
Palliative care encompasses the total suffering of a patient and their family, part of which involves the emotional and psychological stress faced as a result of ill health and treatments.
It is important for patients to have access to a health professional that specializes in mental health that is able to help them work though any psychological issues they may be dealing with.
Fear about the future is often a big concern for palliative care patients and they often feel the need to express this, although if they prefer not to that should also be respected. To help address anxiety the following methods are often used:
- Counseling
- Visualization
- Cognitive methods
- Drug therapy
- Relaxation therapy Stress management as part of palliative care also involves the provision of emotional support, should the patient feel they need it.
References
Further Reading
New initiative aims to set gold standards for palliative care training