A Palliative Approach

  • Improves quality of life for residents with life-limiting illnesses and their families by reducing suffering through early identification, assessment and treatment of pain, physical, cultural, psychological, social and spiritual needs.
  • Is not limited to the last days or weeks of a resident’s life.

When should a palliative approach commence?

1. If the resident has one or more advanced life-limiting illnesses.

2. If the resident’s quality of life is at risk.

3. If treatment goals are ‘comfort care focused’ rather than ‘cure focused’.

Notes:
 
  1. A palliative approach:
  • Offers care and support for residents who are experiencing advanced life-limiting illnesses and their families.
  • Improves the resident’s level of comfort and function by addressing physical, psychological, cultural, social and spiritual needs.
  • Is not limited to the last days or weeks of a resident’s life.
  • Requires care staff to have a positive and open attitude towards death and dying.
  1. A palliative approach to care should be considered if the following are present:
  • If the resident has one or more life-limiting illnesses – e.g. – Heart failure – Respiratory diseases (e.g. chronic obstructive pulmonary disease) – Neurological diseases (e.g. Parkinson’s disease; Alzheimer’s disease and other forms of dementia) – Cancer-related illnesses
  • If the resident’s quality of life is at risk due to physical/psychosocial issues associated with an advanced life-limiting illness – e.g. – Physical (e.g. fatigue; weakness; loss of appetite; weight loss; loss of mobility; pain; breathlessness; confusion/memory loss) – Psychological (e.g. anxiety; sadness; grief; depression)
  • If treatment goals are ‘comfort care focused’ rather than ‘cure focused’. Identifying and responding to a resident’s goals of care requires ongoing and open communication between the resident, the resident’s family and substitute decision maker, and the palliative care team.

Specialized Palliative Service Provision

  1. Some residents may experience complex problems as their condition advances – e.g.
  • Complex physical symptoms
  • Complex psychological distress
  • Complex ethical dilemmas
  • Complex family issues
  1. Specialised palliative service provision:
  • Involves a team of specialist palliative care doctors, nurses and allied health professionals.
  • Provides assistance and support to the care team when a resident is experiencing complex problems.
  1. Specialist palliative care teams do not usually take over the care of the resident – but rather provide expert advice on complex issues and support to GPs and aged care teams.

End of Life (Terminal) Care

  1. End of life (terminal) care is appropriate when a resident is experiencing signs/symptoms indicating that they may be in the last days or week of life (i.e. the terminal phase of life). These signs and symptoms include:
  • Experiencing rapid day-to-day deterioration that is not reversible.
  • Requiring more frequent interventions.
  • Becoming semi-conscious, with lapses into unconsciousness.
  • Increasing loss of ability to swallow.
  • Refusing or unable to take food, fluids or oral medications.
  • Irreversible weight loss.
  • An acute event has occurred, requiring revision of treatment goals.
  • Profound weakness.
  • Changes in breathing patterns.
  1. End of life (terminal) care may require decisions about a resident’s care to be reviewed more frequently.
  2. End of life (terminal) care involves goals more sharply focused on a resident’s physical, emotional and spiritual comfort needs and support for the resident’s family

End of life (terminal) care is urgent care.

Reference

CareSearch 2018. ‘Introduction to a Palliative Approach: Educational Flipchart’, viewed 20 June 2018, <https://www.caresearch.com.au/Caresearch/Portals/0/PA-Tookit/Educational_Flipchart_Introduction_to_a_Palliative_Approach_1.pdf>