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Transition to Palliative Care

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Eilish Buckley

on 8 September 2016

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Transcript of Transition to Palliative Care

Transition to Palliative Care
Philosophies
Affirms life and regards dying as a normal process

Aims neither to hasten nor to postpone death

Aims to provide relief from distressing symptoms

Integration of physical (tinana), social (whanau), emotional (hinengaro) and spiritual (wairua) aspects of care to help the dying person and their family/whanau attain an acceptable quality of life.

Supports family/whanau and carers during the person's illness and their bereavement.
Core Structures
Group focused care - client - family - friends
Holistic
Inter-disciplinary - collaborative team
Coordinated
Continuous
Reviewed
Comprehensive - biomedical/complementary
Talking About Treatment Options
1) Provide relevant information
Otago Community Hospice
Provides palliative care to people who are dying and their families.
Free of charge.
When death is days to years away, and the patient has been accessed as having a disease with little to no prospect of cure.
Whenever the care required is greater than can be provided by their normal community health professional e.g. GP or district nurse.
Can be provided wherever the patient is comfortable, usually at the patient's home.
Most patients don't need to have inpatient care.
What is Palliative Care?
The total care of a person who is dying from active, progressive diseases or other conditions when curative or disease-modifying treatment has come to an end.

Requires the input of a multidisciplinary team, who works with the person whom is dying and their family/whanau.
Use information provided from the multi-disciplinary team, to give relevant information to the patient and their family about diagnoses, prognoses and treatment options.
Adjust it to the culture and wishes of the patient and family.
2) Provide a supportive environment
Give sufficient time for discussion of all options and encourage questions from the patient and their family to reduce anxiety.
Meet individual’s need.

Available whether death is days, weeks, months or years away.

Concurrent with treatments aimed at improving quantity of life.

Available wherever the person may be.

Meet the unique needs of individuals from particular communities or groups. These include Maori, children and young people, immigrants, refugees, and those in isolated communities.
Explain why anti-cancer treatment should be stopped, checking their knowledge about their treatment and recognizing the psychosocial consequences of this discussion.
3) Understand the patient's perspective
4) Extent of Knowledge

People with advanced disease tend to underestimate the extent of their disease, and be overly optimistic about their diagnosis.
Only 20% of seriously ill patients said that their doctor had communicated the seriousness of their illness.
5) Responding to emotional reactions
Display a balance between empathy and medical competence. Acknowledge people's feelings as valid and appropriate.

6) How to bring up palliative care

Let the patient decide when they want to be told about palliative care and make general inquiries for when this is e.g. when the cancer first spreads, in the next few consultations, later when they request it etc.
Early introduction to palliative care reduces fears of abandonment and establishes relationships with the palliative care team.

7) Symptom Control and Quality of Life

Transition to palliative care can take a long time, as people may wish to continue curative or anti-cancer treatments. Their wish to continue curative treatment should be addressed with empathy and understanding. Don't diminish their hope, and explain the full extent of palliative care e.g. symptom control and plans for future treatment.
8) Summary
Give the patient a recording of the conversation, a written summary of the information given and other important information, including referrals to other services e.g. psychological services or pastoral care. This reduces anxiety in the patient and their family, and gives them something to look over later.
Aim:
allow people to remain in their environment, symptom-free, for as long as possible.
Referral
Prognosis for the disease is limited and treatment is focused on quality of life.
Needs level-based referral, not diagnosis-based.
Includes emotional support for family/whanau.
Consent from patient and family to start the palliative care process.
Help within 2 days (SDHB), or sooner if urgent.
Provides:
an initial needs assessment; specialist management of pain, nausea and other physical problems; daily visits (if needed) for maximum comfort; liasion with hospital and community health providers for continuity of care.
References
Schofield, P., Carey, M., Love, A., Nehill, C. and Wein, S. (2006). 'Would you like to talk about your future treatment options?' discussing the transition from curative cancer treatment to palliative care. Palliat med, 20(4), pp.397-406.

Otago Community Hospice. Available at: http://www.otagohospice.co.nz [Accessed 7 Sep. 2016].

Dunedin Hospital Palliative Care Advisory Service Pamphlet

SDHB Palliative Care Advisory Service Referral Guidelines
Palliative Care Should:
Integrated Care Models & Disease Trajectories
Full transcript