Palliative care and Pathways

What’s Palliative care?

WHO states, ‘Palliative care is an approach that improves the quality of life of patients and their families facing theproblem 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:
Provides relief from pain and other distressing
symptoms;
● Affirms life and regards dying as a normal process;
● Intends to neither 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 investigations needed to better understand and manage
distressing clinical complications. (WHO2009) In simple terms palliative care is adding ‘life to days’ not just
days to life – ie, care beyond cure. Combine the art of care and the science of medicine into a cohesive approach to improve the quality of life for the dying patients & their families.

Palliative care pathway

‘An integrated clinical care pathway involving multi-disciplinary teams having the holistic approach to care the patient and to support his/her family or carer throughout the continuum of disease to achieve enhanced quality of life including a dignified death’
● Integrated –
Curative and palliative together
● Multi-disciplinary teams –
includes palliative care doctors, nurses, social workers,
spiritual advisors, dieticians, occupational therapists,
pharmacists, physiotherapists, respiratory therapists,
and volunteers.
● Holistic approach –
patient is viewed as a whole person with physical,
psychological, social, spiritual and cultural gifts and
needs which are special to that person.
● Continuum of disease –
from pre-diagnosis/diagnosis till death and into
bereavement.

 

What matters most to the patient is the key concept in helping the patient to live well with the disease. Assessment
and communication should be a continuous process throughout the continuum of disease. Best suited palliative care pathway will be:
● Patient & family centred – Pt’s needs are the goals of
care. Respect pt.’s & family’s wishes, cultural beliefs
& customs.
● Considering Ethics – Beneficence – Do good
Non- maleficence – Do no harm
Autonomy – Pt’s right to decide
Justice – Fairness
● Addressing – Symptom management; Emotional and
cognitive symptoms; Social challenges;
Understanding of diagnosis & disease progression;
Advance care planning and directives; Functional
status; Spirituality; Issues of grief and bereavement;
Satisfaction and quality of care; Caregiver wellbeing.
● Ensuring clinical interventions/assessments to
occur in time.
● Respecting Physician’s professional responsibility to
discontinue futile medical treatments.
● A team work ensuring continuity of care network
from hospital to home/community/hospice.
● Assuring Quality – by documentation, monitoring
progress using indicators and by high standard of
conduct & practice
● Enabling adherence to guidelines
● Evaluable – by regular audits/reviews
● Including End of life care
Liverpool care pathway (LCP)
– is the most widely used end of life care pathway internationally (version 12 – modified after regular & repeated
evaluations and reviews). It can be adapted to meet the needs of our country. But changes can be made in the best
interest of each patient to individualize the care to best suit that patient as the psych socioeconomic, spiritual & cultural needs are different to each patient.

 

 

Dr (Mrs) Nishanthini Ramesh
Consultant Physician
District General Hospital Vavuniya