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Questions and Answers
What type of support do patients highly value for improving their well-being?
Which of the following factors related to patient concerns was NOT significantly linked to quality of life?
What common barrier do patients face regarding pain management?
What is one of the barriers identified among healthcare professionals in managing cancer pain?
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Which concern was reported least among patients in relation to self-management?
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What is the primary purpose of palliative care?
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When should a patient be referred to palliative care?
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At what point should palliative care assessments begin?
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Who is primarily responsible for ensuring that a palliative care assessment occurs?
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Which of the following settings is appropriate for conducting palliative care assessments?
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Which of the following is NOT a situation that warrants a palliative care assessment?
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Which group requires special consideration when assessing palliative care needs?
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What does good clinical practice dictate regarding palliative care assessments?
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What should be considered when assessing a patient's spiritual concerns?
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When planning care for a patient with spiritual concerns, what is one potential action to take?
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What percentage of patients were found to have depressive states in the study referenced?
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How should complex spiritual concerns be handled according to the assessment guidelines?
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What is an important aspect of eliciting a patient's spiritual history?
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What should be discussed with the patient if a referral to a specialist service is needed?
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What is suggested as a key factor giving hope to patients during illness?
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How may spiritual beliefs affect medical care for patients?
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What is a primary focus of a social assessment?
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Which of the following is NOT a suggested prompt for discussing family support?
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What should be considered when identifying practical concerns during a social assessment?
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What is a primary action after identifying concerns in a social assessment?
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How should emotional and psychological issues be addressed in an assessment?
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When should referral to the Specialist Palliative Care Service be considered?
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What aspect is essential in understanding an individual's emotional support system?
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What should be evaluated after identifying a patient's concerns?
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What is a significant consideration when assessing a patient's psychological well-being?
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Which of the following symptoms may indicate uncontrolled multidimensional pain?
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What should be considered if a patient has a history of mental illness?
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Which question might help assess a person's mood and interest?
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When beginning a spiritual assessment, what is an appropriate initial question?
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What resources should be explored when assessing a patient's strengths?
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Which of the following best describes 'total pain'?
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What action should be taken after identifying a patient's concerns?
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Study Notes
Palliative Care
- Palliative care aims to improve the well-being of patients physically, psychologically, socially, and spiritually.
- Palliative care is given to improve the quality of life for both patients and their families when facing life-limiting illnesses.
- Life-limiting illnesses are progressive and fatal, and their progression cannot be overcome by treatment.
Referral Criteria
- Patients should be referred to palliative care when they are experiencing life-limiting conditions.
- They should also be referred if they are having difficulty managing symptoms, planning for end-of-life, or requiring psychosocial and spiritual support that their current care providers cannot provide.
Assessment Process
- Assessments should be ongoing throughout the patient's illness.
- Key transition points for assessments include:
- Diagnosis of a life-limiting condition
- Episodes of significant disease progression or exacerbation
- Significant changes in the patient's family or social support
- Significant changes in functional status
- At the request of the patient or family
- At the end of life
- Assessments can be conducted in any setting that ensures comfort and privacy, such as the patient's home or hospital.
Assessment Team
- The patient's current health and social care team is responsible for ensuring assessments take place.
- It is helpful to have a single team member responsible for assessing the individual needs of a patient.
- The patient's physician should be involved in the decision to carry out an assessment.
Social and Occupational Wellbeing
- The social assessment aims to understand an individual's life experiences with regard to their:
- Background
- Family support
- Emotional and social support
- Practical concerns
- Suggested prompts for social assessment:
- Who lives with you?
- Do you have any children or adults dependent on you?
- Are there any concerns or worries regarding family or personal relationships?
- Do you have other support, such as home nurses, home help, private carers, friends, or neighbors?
- How often do you see them?
- Do you need more support?
- What would help?
- Discussion about practical issues:
- How are you managing?
- Are you experiencing any difficulties with mobilizing, managing the stairs, or household chores?
- Are you concerned about future care needs, income, finances, and sorting out your affairs?
- Advance care planning:
- What are the person's wishes regarding goals of care, acceptable levels of intervention, and preferred place of care?
- After identification of concerns:
- Elicit history of concerns, including previous supports and interventions received.
- Ascertain the effect of the problem on the patient’s normal activities or functioning.
- Consider treatment options and interventions.
- Action:
- Agree and implement a care plan with the patient and the multidisciplinary team.
- Establish whether these needs can be managed by the current treating team.
- If significant complex family and social concerns are identified or anticipated, consider referral to the specialist palliative care service.
Psychological Well-being
- Patients with life-limiting conditions often have psychological concerns.
- The assessor should be proactive in asking about emotional and psychological issues.
- Approach:
- Begin with an open exploratory question: "Is there anything worrying you?"
- Consider the following:
- Mood and interest
- Adjustment to illness
- Resources and strengths
- Uncontrolled multidimensional pain (total pain)
- Pre-existing mental illness
- Suggested prompts for psychological assessment:
- How is your mood?
- During the last month, have you been feeling down or hopeless?
- Have you lost enjoyment in your interests?
- Are you depressed?
- Do you feel tense and anxious?
- Have you ever had a panic attack?
- Are there things you are looking forward to?
- What is your understanding of your illness?
- What are your sources of support? (Include a range of possible support, such as people, hobbies, faith, and beliefs)
- Is there any psychological, social, emotional, or spiritual issue that may be contributing to your symptoms?
- Persons with a history of current or past mental health problems may be at higher risk of psychological distress.
- After identification of concerns:
- Ascertain the effect of the problem on the patient’s normal activities or functioning.
- Consider treatment options and interventions.
- Action:
- Agree and implement a care plan with the patient and multidisciplinary team.
- Establish whether these needs can be managed by the current treating team.
- If significant complex psychological concerns are identified or anticipated, consider referral to the Specialist Palliative Care Service.
Spiritual Well-being
- People have diverse understandings of spirituality and its impact on their lives.
- Assessors should be aware of alternative terms used to describe spirituality, such as faith, belief, philosophy, religion, and inner strength.
- Approach:
- Use introductory questions to alert individuals to a change in focus from clinical, e.g., "How has this illness impacted your life?"
- Suggested prompts for spiritual assessment:
- What gives you hope (strength, comfort, peace) during this time of illness?
- Are you part or member of a religious or spiritual community? Does it help you?
- What aspects of your spiritual beliefs do you find most helpful and meaningful personally?
- How do your beliefs affect the kind of care you would like me to provide over the next few days/weeks/months?
- After identification of concerns:
- Elicit history of concerns, including previous supports and interventions received.
- Ascertain the effect of the problem on the patient’s normal activities or functioning.
- Consider treatment strategies and interventions.
Action
- Agree and implement a care plan with the patient and the multidisciplinary team.
- This may include referral to pastoral care services.
- Establish whether these needs can be managed by the current treating team.
- If significant complex spiritual concerns are identified or anticipated, consider referral to specialist palliative care services.
On Completion of Assessment
- If specific needs or concerns are identified, establish whether these can be met by the current health and social care team.
- Decide on appropriate actions.
- If the outcome is to refer to the specialist palliative care service, this should be discussed with the patient, and consent should be sought for referral and sharing of information.
Research Findings
- A study found that 76.2% of patients were diagnosed with depressive states, only 19.6% showed no signs of anxiety, and 4.2% did not experience irritation.
- This emphasizes the emotional strain associated with advanced stages of the illness.
- The study highlights the importance of social support, which was linked to less severe mental disorders.
- Patients and caregivers reported maintaining normal routines and turning to family and friends for support in managing symptoms.
- Support from healthcare professionals and complementary and alternative medicine was generally viewed favorably.
Key Concerns
- The most common concerns reported by patients included:
- Self-management concerns (61.2%)
- Psychological symptoms (48.5%)
- Medical information (46.2%)
- Daily living (29.9%
- Pain (17.6%)
- Constipation (15.6%)
- Other physical symptoms (15.2%)
Barriers to Cancer Pain Control
-
Patients and Carers
- Reluctance to complain about symptoms
- Fear of pain and lack of knowledge about how to get help
- Lack of knowledge about strong opioid analgesia
- Fear of adverse effects leading to poor adherence
-
Healthcare Professionals
- Failure to assess pain adequately
- Reluctance to prescribe and monitor effective analgesia
- Providing insufficient education to promote self-management
-
Healthcare Systems
- Failure to recognize patients with cancer pain
- Ineffective communication of pain data
- Delaying patients from receiving timely analgesia
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Description
Explore the essential aspects of palliative care, focusing on its aim to enhance the quality of life for patients with life-limiting illnesses. Understand the referral criteria and the ongoing assessment processes that ensure comprehensive support for both patients and their families in challenging times.
