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Palliative care basics

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A short presentation on the basics of palliative care
Target audience: junior doctors, nursing staff

Published in: Healthcare
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Palliative care basics

  1. 1. Palliative care and pain management at end of life Brooke Sachs 2017
  2. 2. Definition – Palliative care is an approach that improves the quality of life of patients and their families facing the problem 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 - World Health Organization – This encompasses end-of-life care, but is also focused on the transition from ”active management” to quality-of-life care
  3. 3. Important tips and notes – Early referral often makes life easier for patients and their families – Talking to patients and their families about goals of care will help direct services – Commencing on a palliative pathway does not necessarily mean taking away all active treatment – It is not “giving up” on patients – Acute palliation is often more stressful and traumatic for all involved
  4. 4. Goals of care – With any patient, it is important to establish what they want from therapy – For example, some patients will want to get back to work as quickly as possible, while others will want to try as many experimental drugs as possible – Some patients have “bucket lists” while others are very content – Understanding your patient’s perspective will help guide therapy – It is important not to forget a patient’s right to autonomy
  5. 5. End of life care – The priority is comfort (unless the patient has stated otherwise) – Supplementary nutrition or hydration is not indicated – subcutaneous fluids are occasionally used for severe thirst symptoms – Mouth comfort cares can be completed by nursing staff or family – Adequate analgesia is essential – this can be through a syringe driver – Rationalise medications – only give medications that will relieve uncomfortable symptoms – Beware of impaired renal or liver function – Communicate with the patient and their family
  6. 6. Restlessness – Consider causes – pain/discomfort, urinary retention, emotional distress, build up of toxic metabolites, withdrawal – Manage by removing sources of agitation (loud noises), providing familiar staff/family space, music therapy, only sedate if the patient is a danger to themselves or others – Pharmacological management includes haloperidol, clonazepam, midazolam
  7. 7. Secretions – Due to the loss of the swallowing reflex – Not normally disturbing to the patient – Suctioning often increases patient discomfort – Only use medication if the symptoms are very disturbing as they can increase patient discomfort by drying out all surfaces (including eye mucosa etc) – If necessary, use hyoscine hydrobromide of glycopurronium – The ”death rattle” often means death will occur within 24h
  8. 8. Pain – Physical discomfort does not have to be tolerated and can be treated – Titrate analgesia to breakthrough requirements – Consider non-pharmacological methods of pain relieve such as gentle motion, massage etc – If minimal pain requirements, consider ketorolac or ketamine for comfort
  9. 9. Resources – Australian Palliative Care Curriculum modules http://www.pcc4u.org/ – Tasmanian Guidelines for Palliative Care http://www.dhhs.tas.gov.au/__data/assets/pdf_file/0016/47050/Care_Manage ment_Guidelines_-_Terminal_Care_-_20160622.pdf – WHO guide to palliative care http://www.who.int/hiv/pub/imai/genericpalliativecare082004.pdf

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