palliative

Palliative Care

Nurse Talking To Senior Female Patient In Hospital BedThe goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Palliative care is both a philosophy of care and an organized, highly structured system for delivering care. Palliative care expands traditional disease-model medical treatments to include the goals of enhancing quality of life for patient and family, optimizing function, helping with decision-making and providing opportunities for personal growth. As such, it can be delivered concurrently with life-prolonging care or as the main focus of care.

Palliative care is operationalized through effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs and culture(s). Evaluation and treatment should be comprehensive and patient-centered, with a focus on the central role of the family unit in decision-making. Palliative care affirms life by supporting the patient and families goals for the future, including their hopes for cure or life-prolongation, as well as their hopes for peace and dignity throughout the course of illness, the dying process and death. Palliative care aims to guide and assist the patient and family in making decisions that enable them to work toward their goals during whatever time they have remaining. Comprehensive palliative care services often require the expertise of various providers in order to adequately assess and treat the complex needs of seriously ill patients and their families. Members of a palliative care team may include professionals from medicine, nursing, social work, chaplaincy, nutrition, rehabilitation, pharmacy and other professional disciplines. Leadership, collaboration, coordination and communication are key elements for effective integration of these disciplines and services.

Excerpted from Clinical Practice Guidelines for Quality Palliative Care.

American Academy of Hospice and Palliative Care, Position Statement

  • Consultative Service
    • Life affirming, values neutral, focused on quality of care, quality of life
    • Available Monday through Friday 8 AM to 4:30 PM for routine needs, Weekend/Evening availability for urgent needs
    • Team consists of MD, NP, RN with assistance from Social Services and Spiritual Care
    • All consults will be evaluated within a 24 hour time frame and seen within 24-48 hours of receipt. Routine referrals received on the weekend will be addressed on the following Monday.
    • Patients and families can request information and education from the Supportive Care Services/Palliative Care Team. For all referrals, Physician to submit the order for formal consult (Not communication orders)
    • Assist in conducting initial family meetings (establish relationship)
  • Appropriate Supportive Care Services/Palliative Care Referrals
    • NOT just for dying patients
    • Refractory symptoms including pain, dyspnea, nausea, anxiety
    • 2 or more admissions in a 6 month period
    • Prolonged length of stay or in the ICU with poor prognosis
    • Conflict over medical decision-making and goals
    • Help with determining hospice eligibility
    • Appropriateness of artificial feeding prior to tube placement
    • Patient/Family education re: disease trajectory
  • The following conditions fall outside the scope of care for Supportive Care Services/ Palliative Care:
    • Chronic non-malignant pain with no serious/life limiting illness
    • Substance abuse disorder
    • Capacity or competency evaluations
    • Management of acute or chronic psychiatric issues (except on oncology patients)
    • Finding families/guardians
  • MYTHS
    • Palliative Care = Death
    • Palliative Care = Comfort Care = Death
    • Comfort Care always = Morphine Drip
    • Palliative Care = Hospice = Death
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