This document discusses palliative care for terminally ill patients. Palliative care aims to improve quality of life for patients and their families by managing pain and other symptoms from serious illness. It can begin at diagnosis of a life-limiting illness and is not restricted to a certain time period, unlike hospice care which focuses on comfort at end of life. While only 14% receive palliative care, it can help with conditions like cancer, heart disease, and diabetes. Barriers include economic, cultural, and lack of understanding issues. Palliative care addresses physical pain as well as non-physical suffering. Goals of care planning involves discussing patient values and preferences for future treatment.

1. PALLIATIVE CARE OF TERMINAL PATIENTS
Linda Welch, RN, APRN, BC
Annual Ilula International Health Care Conference
January 2023

2. Objectives
1: Describe the philosophy, goals, and practice of palliative care for
patients facing life-threatening illness and their families.
2: Compare and contrast palliative care and hospice care.
3: Discuss palliative care and suffering

3. What is palliative care?
According to the World Health Organization (2002), palliative care is
the “active holistic care of individuals of all ages with serious health-
related suffering due to severe illness, and especially of those near the
end of life to improve the quality of life of patients, their families, and
their caregivers.”
Reference: World Health Organization. (2002) Guidelines and Suggestions for those Starting a Hospice/Palliative Care Service, 3rd edition.
Retrieved December 12, 2022 from http://hospice care.com/what-we-do/publications/getting-started/what-is-palliative-care/

4. Pillars of palliative care
• Palliative care is not disease-specific, and is not restricted to a defined
number of weeks or months.
• Family must also be factored into the care of the patient because it is
impossible to care for a terminally ill person if the needs of the family
are not addressed.
• Palliative care can be initiated as soon as a life-limiting health care
diagnosis is made.

5. Need for palliative care
• Heart disease, cancer, and diabetes are the leading cause of mortality
in the world.
• Additionally, patients with incurable diseases such as AIDS, dementia,
and advanced heart disease could benefit from early palliative care
• *Only 14% of people with the above conditions receive palliative care
services. (Amroud, et Al, 2021).

6. Barriers to palliative care
• Economic
• Cultural
• Social
• Organizational
• Communication barriers
• Lack of understanding
• Treatment-oriented

7. Palliative care and suffering
• 1: Suffering and pain are related, but not necessarily the same. Pain
can have a physical or emotional basis
• 2: Suffering arises when we apply meaning to the pain we are
experiencing.

8. Pain
• 1: Always subjective: clinicians must acknowledge the presence of
and treat both physical pain and nonphysical factors.
• 2: Non-physical pain increases perception of physical pain often
leading to inappropriately high opioid requests.
• 3: Both chronic and acute pain can cause or exacerbate collateral
symptoms which then can lead to increased pain perception.

9. Non-physical pain symptoms (suffering)
• 1: Psychological or emotional pain
• 2: Behavioral pain
• 3: Cognitive pain
• 4: Spiritual/existential pain
• 5: Cultural or sociological pain

10. Collateral pain symptoms
• 1: Insomnia
• 2: Fatigue
• 3: Malaise
• 4: Loss of appetite
• 5: Anorexia
• 6: Depression
• 7: Anxiety

11. The "Doctrine of Double Effect"
• The "doctrine of double effect" (Grauer, 2015, p. 141) supports the
aggressive palliative of pain as different from the active hastening of
death and is ethically justifiable as long as the care provider's primary
intent is to alleviate suffering.
• During the dying process, appropriate doses of opioids or other
medication which may cause respiratory depression, but are given to
alleviate suffering, do not typically cause death. The terminal cause of
the disease is the cause of death.

12. Hospice Care
• Type of care model that focuses on palliation of a terminally ill
patients symptoms at end of life
• Often related to a prognosis of six months or less
• Focuses on comfort and quality of life
• Disease-specific criteria, and the expected disease trajectory all help
to make a case for hospice admission.

13. Goals of Care: Advanced Care Planning
• 1: Collaborative effort between patient, healthcare provider, and
families
• 2: Patient establishes their preferences for future medical treatments
• 3: Patients express their wishes through the development of a living
will, or designating a person who can speak on their behalf if they are
not able to make decisions for themselves.
• 4: Advance directives are used to guide care only when the patient is
unable to speak or make decisions for themself.

14. Leading a Goals of Care Conversation
• 1: Determining a patient's values
• 2: Establishing leeway in substitute decision-making
• 3: Aligning language with the patient's preferred mode of decision-
making

15. Questions?

16. References
• A., Raeissi, P., Seyed-Masoud, H., Reise, N., Ahmad, A. Investigating the challenges
and barriers of palliative care delivery in Iran and the World: A systematic review
study. Journal of Heath education and Promotion; 2021; 10: 246. doi:
10.4013/Jeep.jehp_1325_20
• Doyle, D. (2022). What is Palliative Care: Guidelines and Suggestions for those
Starting a Hospice/Palliative Care Service. (3rd edition). International Hospice and
Palliative Care. Retrieved December 12, 2022, from: https//hospice
care.com/what-we-do//publications/getting-started/what-is-palliative-care
• Isangula, KG. (2022) The Dangers of Being Old in Rural Tanzania: A Call for
Interventions for Strengthening Palliative Care in Low-Income Communities.
Frontiers in Aging 3.888396.doi: 10.3389/fragi.2022.888396