Palliative Care - Latest Developments and Demands and Challenges
Palliative care is an essential health care delivery system to improve the quality of life for the patients suffering from serious illnesses and also helps the patients’ family, through prevention and relief of suffering by early identification, precise assessment and treatment of problems that can be physical, psychosocial or spiritual.
A serious illness not only affects the body but it affects all aspects of person’s life and their family members. The goal of palliative care is to help patients and families feel better and to improve the quality of life for both. Palliative care should begin alongside disease treatment. It should ideally start when the illness is diagnosed, but can also be started at any time of disease treatment, during follow-up, and even at terminal stages irrespective of the age group of patients.
Palliative care comprises of an interdisciplinary team of doctors, nurses and other specialists(dieticians, psychologists, counsellors, physiotherapists, massage therapists) who after taking proper guidance from patient’s doctor work together for the benefit of the patient and provide an added layer of support for patients fighting with such serious illnesses. Palliative care can be offered to the people with serious illnesses (cancer, heart disease, lung disease, kidney failure, dementia, HIV/AIDS, depression also) chronically or terminally ill and patients who require prolonged hospitalisation.
The rationale behind palliative care services is:
- To alleviate patient’s symptoms (most distressing symptoms are pain, difficulty in breathing, fatigue, trouble in sleeping, anxiety and depression).
- To have a realistic understanding of the illness.
- Allows patients to avoid frequent and long hospitalisation, reduce post-traumatic stress.
- To build better patient and family satisfaction and thus help in improving the overall quality of life of both patients and their family members.
- It also takes care of the finances as it helps avoiding unnecessary hospitalization, diagnostic interventions.
- Patients hospitalised in intensive care units (ICUs) also benefit from early palliative care as they get shorter stays and early discharge.
Palliative Care Services
Treatment of symptoms:
Main emphasis is on relieving the symptoms of patients that can be physical, psychosocial, and emotional. Most commonly experienced physical symptom is pain. Inefficiency in pain management may lead to unnecessary hospital visits and untreated pain which can also lead to serious complications, for example physiotherapy sessions augmented with good diet and massage therapies (if patient wants) at home can greatly improve mobility post surgically.
Social, emotional, mental, spiritual and bereavement support are key elements of palliative care. Stress of prolonged illness, discomfort due to physical symptoms or concern for family members are the most common reasons for depression in patients with chronic and terminal diseases. Depression if untreated may further worsen the patient’s condition with decreased functional capacity, poorer quality of life, and a desire for hastened death. Treatment includes antidepressant therapy, supportive psychotherapy and counselling Another key element is taking care of patient’s family members and caregivers. It has been recognised that most family caregivers of seriously ill patients or patients who are hospitalised long term also bear stress and are prone to illnesses. Thus, attention should be given to both the patients and family caregivers.
Plays an integral role in palliative care for gravely ill patients as spiritual distress correlates with desire for a hastened death and thus should be taken care of.
Coordination of care:
Palliative care services can be provided in hospital, ambulatory setting, nursing homes and in home. Palliative care programmes provide proper guidance and support to patients and caregivers to help them understand the care plans pre and post treatment keeping in mind their needs and resources. It also provides financial counselling to caregivers for better understanding of expenses.
The demand for palliative care services is huge. It is most beneficial when started early, in the disease course as it greatly improves quality of life, mood, and end-of-life care. It can also have influence in prolonging the life but doesn’t affect survival much. Even though the need and benefit for palliative care is well recognised, still palliative care team faces many challenges. The biggest challenge is to continuously adapt to the different care giving plans, to meet the specific needs and values of each patient. Others are the low awareness among patients and families, limited resources and sometimes resistance to referral for palliative care and shortage of palliative staff.