When a person and their loved ones are informed that they require palliative care, it can be an emotional and confronting experience. It is natural to experience fear when hearing the words “palliative care” for the first time, but the process can be made simpler with the correct information and support.
A person receiving palliative care is essential towards the end of their life, and a major focus is on keeping them comfortable so they can live out their remaining time on earth — with an emphasis on quality of life rather than counting the days.
The World Health Organization defines palliative care as “the active, comprehensive care of patients whose condition is incurable.” Controlling pain, other symptoms, and psychological, social, and spiritual issues are of the utmost importance. Palliative care aims to achieve the highest possible quality of life for patients and their families.
Palliative care can appear frightening, but it is primarily a support system designed to help a patient and their loved ones deal.
The fundamentals of palliative care
Palliative care is not merely a hospital-based process that a patient undertakes alone. This idea is integrated into their overall care and the care provided to their family.
Palliative care:
- It affirms life and considers death a natural process.
- Neither accelerates nor delays death.
- Provides pain and other uncomfortable symptom relief
- Care that integrates the psychological and spiritual dimensions
- It offers a support system to assist patients in living as fully as possible till their death
- It offers a support structure to help patients’ families deal with their illness and their own loss.
Pain management
Physical discomfort is a regrettable component of a variety of terminal diseases. Although pain is a common symptom, not all patients receiving palliative care may experience it.
Therefore, pain management should address the physical, psychological, social, and spiritual components of suffering.
As pain is complex and multidimensional, there is no single treatment method. Physical pain cannot be addressed without its psychological and anxious aspects. And vice versa, the mental anguish cannot be addressed in isolation from physical suffering.
The fundamental principle of pain management is an accurate and comprehensive evaluation of the source of the pain. Keep in mind that patients may experience pain in multiple areas and that different types of pain have distinct origins.
They urge that pain medicine be administered “by the clock,” or every 3 to 6 hours, rather than “on demand.”
If pain occurs, the following medications should be used orally as soon as possible:
- Non-opioid medications (aspirin, paracetamol);
- Then, when required, moderate opioids (codeine);
- Then, potent opioids such as morphine are administered until the patient is pain-free.
- Extra medications, or “adjuvants,” must be administered to alleviate dread and anxiety.
For effective pain management, a full understanding of the underlying pathophysiology of pain is needed. The three-step method of providing the correct drug at the right time and in the right amount is expected to be cost-effective and 80-90% efficient.
Consideration must always be made to treating the underlying source of the pain, which may involve surgery, radiotherapy, chemotherapy, or other therapies.
Where may individuals obtain palliative care?
When possible, palliative care is offered where the patient and their family prefer. It is not restricted solely to clinical or hospital settings.
This may consist of:
- Residing at home
- In healthcare
- Within a hospice.
- In an elderly residential care facility
Numerous individuals express a desire to die at home, but the ability to do so frequently depends on several factors, such as the nature of the illness, the level of care required, the availability of family support, and the presence of someone who can provide physical care and emotional support.
Palliative care strives to alleviate physical pain and psychological, social, and spiritual suffering while preserving the patient’s racial, ethnic, and cultural values. Like any excellent patient care, Palliative care is founded on the ethical concepts of autonomy, beneficence, nonmaleficence, fairness, and duty.
In addition to hospice and end-of-life care, palliative care encompasses the management of pain and suffering in medical and surgical diseases throughout life. If palliation refers simply to end-of-life care or “comfort measures only,” it excludes the life-affirming character of active, symptomatic efforts to alleviate the pain and suffering of those with chronic illness and injury. In this regard, palliative care is essential for managing a wide variety of surgical patients, not just those at the end of life.
The background and practice of surgery emphasise the significance of pain management alongside illness treatment. In addition, by adhering to the professional norms established by the American College of Surgeons, the surgeon is in a position to advocate for palliative care for all patients. For more information click here.
Statement of palliative care principles
- Respect the autonomy and dignity of patients, surrogates for patients, and carers.
- Respect the patient’s or surrogate’s freedom to choose therapies, even those that may or may not prolong life.
- Effectively and compassionately communicate with patients, their families, and caregivers.
- Identify the key goals of treatment from the patient’s perspective, and explain how the surgeon’s care can help reach those goals.
- Make an effort to alleviate pain and other bothersome physical and mental symptoms.
- Identify, evaluate, discuss, and provide service access for psychological, social, and spiritual concerns.
- Provide access to therapeutic support, ranging from life-prolonging treatments to hospice care, when they can realistically be expected to enhance the patient’s perception of their quality of life.
- Recognise the physician’s duty to oppose therapies unlikely to accomplish the patient’s goals, and encourage patients and families to consider hospice care when survival is expected to be less than six months.
- Facilitate continuity of care by the patient’s primary and specialised physician, mitigating the sense of abandonment that patients may have when “curative” therapy is no longer effective.
- Maintain a professional and empathetic demeanour toward those tasked with the patient’s care.
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