Palliative care is a multidisciplinary approach to specialized medical and nursing care for people with life-limiting diseases. It focuses on providing relief from symptoms, pain, physical stress, and mental stress from terminal diagnosis. The goal is to improve the quality of life for both personal and family. The evidence in 2016 supports the efficacy of palliative care in improving the quality of life of patients.
Palliative care is provided by a team of doctors, nurses, physiotherapists, occupational therapists and other health professionals who work with primary care physicians and referral specialists and other hospital or hospital staff to provide additional support. Appropriate for any age and at any stage in serious illness and can be given as a primary goal of care or along with curative care. Although this is an important part of end-of-life care, it is not limited to that stage. Palliative care can be provided in a variety of settings including in the hospital, at home, as part of a community palliative care program, and in a skilled care facility. Interdisciplinary palliative care teams work with people and their families to clarify treatment goals and provide symptom management, psycho-social, and spiritual support.
Doctors sometimes use the term palliative care in the sense that palliative therapy is without curative intent, when no drug can be expected (as is often the case with end-stage cancer). For example, tumor debulking can continue to reduce pain from mass effects even when it is no longer curative. Clearer usage is palliative, noncurrent therapy when that is what it means, because palliative care can be used in conjunction with curative or aggressive therapy.
Drugs and treatments are said to have a palliative effect if they relieve symptoms without having a curative effect on the underlying disease or cause. This includes treating nausea associated with chemotherapy or something as simple as morphine to treat leg pain or ibuprofen to treat pain associated with influenza infection.
Video Palliative care
Medical use
Palliative care is given to people who have serious illnesses and who have physical, psychological, social or spiritual disturbances as a result of the care they seek or receive. Palliative care improves comfort by reducing pain, controlling symptoms, and reducing stress for patients and families, and should not be delayed when indicated. Evidence suggests that late-life communication interventions reduce use (such as length of stay), particularly in the regulation of intensive care units, and that palliative care interventions (mostly in outpatient settings) are effective for improving patient perception and caregiver care.
Palliative care is not provided for people undergoing end-of-life care and can improve quality of life, reduce symptoms of depression, and improve survival time. If palliative care is indicated for someone in the emergency department, the treatment should be initiated in the emergency department immediately and with referral to additional palliative care services. Emergency care physicians are often the first medical professionals to open discussions about palliative care and hospital services with people in need of care and their families.
In some cases, professional medical specialist organizations recommend that sick people and doctors respond to illness only with palliative care and not with disease-induced therapies. The following items are indications named by the American Society of Clinical Oncology as characteristic of a person who should receive palliative care but no cancer-induced therapies.
- people with limited ability to care for themselves
- people who did not receive benefits from previous evidence-based care
- people who are not eligible to participate in the appropriate clinical trials
- doctors do not see solid evidence that treatment will be effective
This characteristic may be generally applicable to conditions other than cancer.
Maps Palliative care
Term coverage
Palliative care is a term derived from Latin palliare, "for robes." This refers to special medical care for people with serious illness. It focuses on providing people with the help of symptoms, pain and stress from serious illness - whatever the prognosis. The goal is to improve the quality of life for both the sick and the family as they are the central system for care.
The World Health Organization statement describes palliative care as "an approach that improves the quality of life of patients and their families with issues related to life-threatening illnesses, through the prevention and recovery of suffering by means of early identification and assessment and the perfect treatment, pain and other problems, physical, psychosocial and spiritual. "More generally, however, the term" palliative care "may refer to any treatment that relieves symptoms, whether or not there is hope of healing in other ways; thus, palliative care may be used to reduce the side effects of curative treatments, such as relieving chemotherapy-related nausea.
The term "palliative care" is increasingly being used in relation to non-cancer diseases such as chronic lung disease, progressive, kidney disease, chronic heart failure, HIV/AIDS and progressive neurological conditions. In addition, the rapidly growing field of pediatric palliative care has clearly demonstrated the need for specialized services for children with serious illness.
While palliative care may seem to offer a variety of services, the goal of palliative care is concrete: relief from suffering, pain treatment and other deplorable symptoms, psychological and spiritual care, support systems to help individuals live as actively as possible and support systems to maintain and rehabilitate individual families.
Starting in 2006 in the United States, palliative medicine is now a certified sub-specialty of internal medicine with special scholarships for physicians interested in this field.
Comparison with hospice
In the United States, differences must be made between palliative care and hospital care. Hospital services and palliative care programs share the same goals in providing symptomatic relief and pain management. Palliative care services can be appropriate for anyone with a serious complex illness, whether they are expected to fully recover, to live with chronic illness for a long time, or to experience the progression of the disease.
Hospital care focuses on five topics: communication, collaboration, loving care, comfort, and cultural (spiritual) care. The end-of-life care at the hospital is different from hospital care because medical staff and support staff specialize in treating only the severely ill. This specialization enables staff to handle legal and ethical issues around death more thoroughly and efficiently with survivors of patients. Home comfort treatments also differentiate as patients are treated to continue to manage an unfortunate relief treatment while sickly ailing patients receive hospitalized care because of late or poorly controlled life-threatening symptoms or out-patient outpatient assistance efforts.
Hospice is a type of treatment that involves palliation without curative intent. Usually, it is used for people who have no further option to cure their illness or in people who have decided not to pursue further difficult choices, tend to cause more symptoms, and are unlikely to succeed. Hospital care under Medicare Hospice Benefit requires that two doctors declare that a person has less than six months to live if the disease follows a normal course. However, this does not mean that if someone is alive after six months in a nursing home, he will be discharged from the service.
The philosophy and approach of multi-disciplinary teams is similar to hospitals and palliative care, and indeed training programs and many organizations provide both. The biggest difference between home care and palliative care is the type of illness people have, where they are in their disease primarily related to the prognosis, and their goals/desires regarding curative treatment.
Outside the United States there is generally no division of terminology or funding, and all such treatments with palliative focus especially, whether for people with terminal illness or not, are usually referred to as palliative care.
Outside the United States the term home care usually refers to a building or institution that specializes in palliative care, rather than to a particular developmental stage of care. Such institutions may be primarily specialized in providing care in the final setting of their lifetime; but they may also be available to people with other palliative care needs.
Comfortable Treatment at the Hospital
Despite the fact that many individuals are now dying either at home or at a nursing facility, in 2010, 29% of all deaths in the United States occurred in hospitals, this statistic increases in 2016 to about 60% of all deaths occurring. at the hospital which is a substantial increase from 2010. which is still a considerable percentage. Convenient care can require very careful techniques to reduce the disruption caused by severe health problems towards the end of life. Doctors, nurses, nurses, social workers, pastors, and other hospital support staff work systematically together to carry out final care and comfort at the hospital. Hospitals are able to accommodate requests for acute medical care as well as education and supportive therapies for the families of their loved ones. In hospital settings, there is an increase in the shortage of certified palliative care specialists. This deficiency results in the responsibility of comfortable treatment falling on the shoulders of others.
Comfortable treatment at the hospital is different from the convenient care at home care because the patient's end-of-life symptoms are uncontrolled before checking in. The mean time between death and entry of severely ill patients was 7.9 days. Patients who receive end-of-life care at home care usually have a longer time between admission and death; 60% of hospital patients pass within about 30 days after admission. The average length of stay in the care home from entry to death is about 48 hours.
Practice
Assessment of symptoms
Methods for symptom assessment of people treated for palliative care are the Edmonton Symptom Scale Score (ESAS), where there are eight visual analog (VAS) scales 0 to 10, shows the level of pain, activity, nausea, depression, anxiety, drowsiness, appetite and sensation of well-being, sometimes with the addition of shortness of breath. On a scale, 0 means that the symptoms do not exist and 10 that it is the worst possible severity. This is done either by people who need self-care, by people with nursing assistance, or by nurses or relatives.
End-of-life care
The drugs used in palliative care are used differently than standard drugs, based on established practices with varying levels of evidence. Examples include the use of antipsychotic drugs to treat nausea, anticonvulsants to treat pain, and morphine to treat dyspnea. The route of administration may differ from acute or chronic treatment, as many people in palliative care lose the ability to swallow. The usual alternative route of administration is subcutaneous, because it is less traumatic and less difficult to maintain than intravenous drugs. Other administrative routes include sublingual, intramuscular and transdermal. Drugs are often managed at home by family or nursing support.
Palliative care interventions in care homes can contribute to decreasing discomfort for residents with dementia, and to improve family members' views of the quality of care. However, higher quality research is needed to support the benefits of this intervention for parents who died at the facility.
Dealing with distress
For many, knowing that the end of life is approaching induces various forms of emotional and psychological distress. The key to effective palliative care is to provide a safe way for individuals to overcome their difficulties, meaning to say their total suffering , the concept first thought by Cicely Saunders, and now widely used, for example by the author such as Twycross or Woodruff. Dealing with total suffering involves a variety of concerns, starting with treating physical symptoms such as pain, nausea and shortness of breath with various drugs. Usually, the concerns of sick people are pain, fear about the future, loss of independence, worries about their family and feel like a burden. Interdisciplinary teams also often involve a licensed mental health professional, a licensed social worker, or a counselor, as well as spiritual support such as a pastor, who can play a role in helping people and their families cope. There are five main methods for dealing with patient anxiety in palliative care settings. They are counseling, visualization, cognitive methods, drug therapy and relaxation therapy. Palliative animals can play a role in this last category.
Total Pain
To treat the patient's pain in the End of Life, one must understand that it is the most important to keep Total Body Pain. Total Body Pain is the sum of all the physical, psychosocial, and spiritual pain they can sustain at this stressful time. When a person is at the end of their life and they are looking for a comfortable treatment, most of their time is in great pain. This pain can be a physical manifestation in which their body starts against itself causing many physical symptoms. Pain can be a psychosocial manifestation and can be handled by medical teams who have open communication about how to cope and prepare for death. The last aspect of pain included in Total Body Pain is a manifestation of spiritual pain; if the patient's spiritual needs are met, then research shows that they will be more likely to get home care treatment. Addressing the Total Body Pain requirement can result in a better overall quality of life for the patient.
Physical Pain
Physical pain can be managed in a way that uses adequate pain medication as long as they will not put the patient at further risk to develop or improve a medical diagnosis such as heart problems or difficulty breathing. Patients at the end of life may exhibit many physical symptoms that can cause extreme pain such as dyspnea (or difficulty breathing), Cough, Xerostomia (Dry Mouth), Nausea and Vomiting, Constipation, Fever, Delirium, Oral Secretion and Excessive Pharynx (" Death Rattle ") and many more painful symptoms can be seen that they hope to get pain relievers.
Once immediate physical pain has been addressed, it is important to remember to be an affectionate and empathetic caregiver who is there to listen and be there for their patients. Being able to identify the sad factors in their life apart from the pain can help them become more comfortable. When a patient has their needs met then they are more likely to be open to the idea of ​​hospice or care beyond comfortable care. Having a Psychosocial assessment allows the medical team to help facilitate a patient-family healthy understanding of adjustment, handling and support. This communication between medical teams and patients and families can also help facilitate discussions about the process of maintaining and improving relationships, finding meaning in the dying process, and achieving a sense of control when facing and preparing for death.
Spiritual Pain
When a patient is at the end of life, one of the most important things that many of them want to talk to their doctor is their spirituality. Despite this desire, less than 50% of doctors believe that it is their duty to address this religious issue, and only a small percentage of patients recorded have met their spiritual needs. Most of the time these patients are referred to Chaplain services if they are available or they rely on available medical staff and any family and friends that may be there as well. Chaplain service is one of the best services available to meet this spiritual need. That being said, there are not enough Pastors available at one time and the majority of them are not eligible to provide services to Comfort Care patients who often have the most serious illness. According to some site cohort studies involving 343 advanced cancer patients, it was found that those who meet their religious needs were more likely than those who did not meet their religious needs for hospital treatment and did not get unnecessary. care at the end of life, and research shows that they have a higher quality of life than those who do not meet their spiritual needs.
Palliative care of children
Palliative care for children and adolescents is an active and total approach to care, from the point of diagnosis, throughout a child's life, death, and so on. It includes physical, emotional, social and spiritual elements and focuses on improving the quality of life for children or young people, and support for the whole family. These include management of distressing symptoms, provision of short breaks, end-of-life care and mourning support.
Palliative care can be introduced at any point throughout the life of a child; it's really individual. Some children may require palliative care from birth, others simply because the condition worsens. Families can also vary whether they want to perform treatments that aim to heal or prolong life significantly. In practice, palliative care should be offered from the diagnosis of life-limiting conditions or the recognition that curative treatment for life-threatening conditions is not an option; However, every situation is different and care must be tailored to the child.
Terminology
- The conditions that limit life/shortening lives are those that have no hope of recovery and from which children or young people will die. Some of these conditions lead to a progressive decline that makes the child more dependent on parents and guardians.
- Life-threatening conditions are conditions in which curative treatment may be feasible but may fail, such as cancer. Children in long-term remission or following successful healing treatment are not included.
Child Palliative Care Children (by country) /h3> English
There are about 49,000 children and teenagers in the UK living with life-threatening or life-threatening conditions that may require palliative care. A 2015 survey of the Royal College of Nursing (RCN) found that nearly a third of child nurses say they do not have the resources to provide adequate care at home.
History
Palliative care begins in the home care movement and is now widely used outside traditional home care treatments. Hospisia was originally a break for tourists in the 4th century. In the 19th century, a religious order established care homes for the dying in Ireland and London. Modern home care is a relatively new concept that originated and gained momentum in the United Kingdom after the establishment of St. Christopher in 1967. The house was founded by Dame Cicely Saunders, who is widely regarded as the founder of the modern care home movement. Dame Cicely Saunders, went to St.Thomas Hospital in 1944 to become a nurse. After working with a severely ill man he went and became a doctor in 1957 so he could start his own nursing home. Dr. Cicely Saunders then opened his own nursing home after he saw all the severely ill patients that he was treated in extreme pain because their pain was not managed as they should.
In the UK in 2005 there were fewer than 1,700 hospital services consisting of 220 inpatient units for adults with 3,156 beds, 33 inpatient units for 255 beds, 358 home care services, 104 nursing homes in home services, 263 child care services and 293 team hospitals. This service together helped more than 250,000 people in 2003 and 2004.
Hospital care in the United States has grown from a volunteer-led movement into an important part of the health care system. In 2005 about 1.2 million people and their families received hospital treatment. Hospice is the only Medicare benefit covering drugs, medical equipment, twenty-four hours/seven days per week access for care and support for loved ones after death. Most hospital care is delivered at home. Hospital care is also available for people in hospice homes such as homes, nursing homes, assisted living facilities, veterans facilities, hospitals, and prisons.
The first hospital-based palliative care consultancy service in the United States was developed by the Faculty of Medicine at Wayne State University in 1985 at the Detroit Receiving Hospital. The first palliative treatment program in the United States began in 1987 by Declan Walsh, MD at the Cleveland Clinic Cancer Center in Cleveland, Ohio. It is a comprehensive integrated program, responsible for several important innovations in US palliative medicine; first clinical and research associations (1991), acute care palliative care units (1994), and Chair in Palliative Medicine (1994). The program evolved into The Harry R. Horvitz Center for Palliative Medicine which was designated an international demonstration project of the World Health Organization and accredited by the European Community for Medical Oncology as the Center for Integrated Oncology and Palliative Care. Other programs follow: the most notable is the Palliative Care Program at the Medical College of Wisconsin (1993); Pain and Pain Care Services, Memorial Sloan-Kettering Cancer Center (1996); and Palliative Care Institute Lilian and Benjamin Hertzberg, Mount Sinai School of Medicine (1997). Since then there has been a dramatic increase in hospital-based palliative care programs, now numbering more than 1,400. Eighty percent of US hospitals with more than 300 beds have programs.
A widely cited report in 2007 from a randomized controlled trial with 298 patients found that palliative care provided to patients and their home care nurses increased satisfaction with care while reducing the use of medical services and maintenance costs.
A 2009 study on the availability of palliative care in 120 US cancer center hospitals reported the following: only 23% of centers had beds dedicated to palliative care; 37% offer hospital care; 75% had median time referral to palliative care up to the time of death 30 to 120 days; research programs, palliative care fellowship, and mandatory rotation for oncology associates are rare.
Results from a 2010 study in The New England Journal of Medicine showed that people with lung cancer who received initial palliative care in addition to standard oncology treatments experienced less depression, improved quality of life and survived 2.7 months more long. than those who received standard oncology treatments.
In 2011, The Joint Commission (an independent, not-for-profit organization that accredits and certifies thousands of health care organizations and programs in the United States) initiates an Advanced Certification Program for Palliative Care that recognizes in-patient hospitalization. To obtain this certification, hospitals must demonstrate superior care and improved quality of life for people with serious illness.
The first pan-European center aimed at improving palliative care and end-of-life care was established in Trondheim, Norway in 2009. The center is based at the NTNU Medical Faculty and at St. Hospital. Olav/University Hospital of Trondheim and coordinate efforts between individual groups and researchers across Europe, in particular Scotland, England, Italy, Denmark, Germany and Switzerland, together with the United States, Canada and Australia.
Society
Cost and funding
The families of people who receive referral to palliative care during hospitalization bear less expenses than people with similar conditions who do not receive referral palliative care.
Funding for hospice and palliative care services varies. In the United Kingdom and many other countries all palliative care is offered free, either through National Health Services (as in the UK) or through charities working in partnership with local health services. Palliative care services in the US are paid by philanthropy, fee-for service mechanism, or from direct hospital support while hospital care is provided as a Medicare benefit; Similar hospital benefits are offered by Medicaid and most private health insurance companies. Under Medicare Hospice Benefit (MHB), a person signs Medicare Part B (acute hospital payment) and enrolls in MHB through Medicare Part B with immediate care provided by a Medicare certified hospital agent. Under the terms of MHB, the Hospice agent is responsible for the Treatment Plan and can not charge the person for the service. A nursing home agent, along with one's primary physician, is responsible for determining a Treatment Plan. All expenses related to terminal illness are paid from the per diem (~ US $ 126/day) rate received by Medicare hospital agents - this includes all drugs and equipment, nursing, social services, chaplain visits and other services deemed appropriate by the agency hospice; Medicare does not pay for custodial care. One can choose to withdraw from MHB and return to Medicare Part A and then re-register at care home.
Certification and training for services
In most countries hospital care and palliative care is provided by an interdisciplinary team consisting of doctors, pharmacists, registered nurses, nursing assistants, social workers, hospice pastors, physiotherapists, occupational therapists, complementary therapists, volunteers, and most importantly, families. The team's focus is to optimize one's comfort. Additional members of the team will likely include certified nursing assistants or home health care aides, community volunteers (mostly untrained but some are skilled medical workers), and domestic helpers. In the United States, a subspecialty of hospital doctors and palliative medicine was established in 2006 to provide expertise in the care of people with life-limiting diseases, advanced disease, and catastrophic injuries; pain relief symptoms; coordination of interdisciplinary care in a variety of settings; use of specialized care systems including home care; the management of dying patients; and legal and ethical decision making in end-of-life care.
Caregivers, both family and volunteers, are essential to the palliative care system. Caregivers and carers often form lasting friendships during the treatment. As a result, caregivers may find themselves under severe emotional and physical stress. Opportunities for upbringing are some of the hospice services provided to promote the welfare of caregivers. Tangguh can take several hours to several days (the latter is done by placing a primary person who is admitted to a nursing home or inpatient hospice unit for several days).
In the US, board certification for physicians in palliative care is through the American Board of Hospice and Palliative Medicine; was recently changed to take place through one of 11 different special boards through approved American Board of Medical Specialties procedure. In addition, board certification is available to osteopathic doctors (D.O.) in the United States through four specialist medical boards through the American Osteopathic Association of Osteopathic Specialists-approved procedure. Over 50 scholarship programs provide one to two years of specialized training after the main residency. In the UK palliative care has been a treatment specialty since 1989 and its training is governed by the same rules through the Royal College of Physicians as with other medical specialties. Nurses, both in the United States and internationally, can receive continuing education credits through special Palliative Care training, such as those offered by the End-of-Life Nursing Education Consortium (ELNEC)
At India's Tata Memorial Center, Mumbai has started a doctor's course in palliative medicine for the first time in the country since 2012.
Regional variations in the service
In the United States, home care and palliative care represent two different aspects of treatment with similar philosophies, but with different payment systems and service locations. Palliative care services are most often provided in acute care hospitals held around interdisciplinary consulting services, with or without an acute care unit of palliative care. Palliative care may also be provided at the homes of the person who is dying as a "bridge" program between traditional US home care services and hospital care or provided in long-term care facilities. In contrast more than 80% of hospital care in the US is provided at home with the remainder given to people in long-term care facilities or in a free-standing hospice housing facility. In British hospitals it is seen as one part of palliative care specialization and no differentiation is made between 'home care' and 'palliative care'.
In the UK palliative care services offer inpatient care, home care, daycare and outpatient services, and work in close partnership with key services. Home care often provides various services and professionals for children and adults. By 2015 palliative care UK is classified as the best in the world "due to comprehensive national policies, extensive integration of palliative care into the National Health Service, strong home care movement, and deep community involvement on issues."
Reception
The focus on a person's quality of life has improved greatly since the 1990s. In the United States today, 55% of hospitals with more than 100 beds offer palliative care programs, and nearly one fifth of community hospitals have palliative care programs. A relatively recent development is the palliative care team, a dedicated health care team that is fully geared toward palliative care.
Physicians who practice palliative care do not always receive support from the person they care for, family members, health care professionals or their social partners. More than half of the doctors in one survey reported that they had at least one experience where family members of patients, other doctors or other health care professionals have characterized their work as "euthanasia, murder or murder" for the past five years. A quarter of them have received similar comments from friends or family members of their own, or from a patient.
See also
References
External links
- Family Caregiver's Guide to Hospice and Palliative Care
- Palliative Care Treatment in Curlie (based on DMOZ)
- NCPC National Council of England for Palliative Care
- All Institution of Hospice Care and Palliative Care Ireland
- Scottish Partnership for Palliative Care
- Palliative Hub
- Palliative Hub - Adult
- Palliative Hub - Learning Platform
- Palliative Hub - Children and Youth
- Increase Access to Palliative Care
Source of the article : Wikipedia
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