T3 Systems Palliative Care PDF

5. Cancer - Palliative Care While technically speaking, the term “palliative care” refers to any type of treatment that is not geared toward curing a condition, increasingly the term is understood to be synonymous with care of the dying. Palliative Care: the set of treatment approaches that begi...

5. Cancer - Palliative Care While technically speaking, the term “palliative care” refers to any type of treatment that is not geared toward curing a condition, increasingly the term is understood to be synonymous with care of the dying. Palliative Care: the set of treatment approaches that begin after a person receives a terminal diagnosis Hospice Care: generally refers to when life expectancy is less than 6 months; it can take place at home, in a hospice facility, in hospital Palliative care approaches are seen as having two primary purposes: Relief of Suffering: treatments that alleviate or improve pain, discomforts and distress from physical and psychoemotional symptoms Quality of Life: treatments focused on boosting the person’s enjoyment of their remaining life – this of course involves relief from S/S, but also: o comfort/support/nurturance o engagement, reduction of isolation o improvement of processes like digestion, sleep o optimizing mobility and day-to-day functionality o assisting with discomforts of being in a wheelchair or in bed for long hours o skin care: skin health support, decubitus ulcer prevention o reduction of medication use to the extent possible, especially those that fog the person’s brain o assistance with processing the journey toward death o assistance with helping involved family/friends feel like meaningful participants, incl. facilitating communication and resolution o assistance with managing the logistics of closing out their lives, esp. if family are unable to help Patients receive comfort and care “physically, mentally, emotionally and spiritually.” ˃ In your opinion, which of these treatment goals do you think match best with what massage therapy has to offer? Research to date suggests massage therapy’s best efficacies in palliative care are: pain reduction, pain management improvement of S/S, reduction of symptom distress more comfortable/workable body for day-to-day activities, extended sense of being able to do things for oneself better stress management, decreased anxiety and/or “feeling low”, enhanced sense of well-being and peace promotion of better-quality sleep, stronger appetite benefits of 1-on-1 focus, tx adapted to the person’s specific needs at the time someone neutral to talk to/confide in caregiver support may be part of the role ˃ Do you think the RMT providing palliative care has a different clinical mindset than when working with someone whose S/S stem from more everyday causes? If yes, in what way? RMT Considerations in Palliative Cases 1. Consent Issues: 2. Intake Considerations: Regardless of an intention to provide “lighter” or “gentler” treatment, we have to have as complete a picture as possible of the patient’s systems health and specific frailties in relation to receiving massage therapy. Heart status, blood pressure, and kidney function are often the most pertinent.  Helping relieve S/S involves trying to be as effective as possible, for example, in reducing edema, in optimizing joint mobility and/or muscle strength, in working with scars, etc. – determining how much rigour is possible in using pressure, hydro, circulatory techniques, and mobility enhancing modalities is an important part of being effective. Are there any unhealed or partially healed injuries or surgical sites? Any current or recent decubitus ulceration? Has the person had, or is currently receiving, radiation or chemotherapy? Get specific information about this history, incl. radiation sites, chemo ongoing effects Are there concerns about bone friability? Current ADLs, incl. hydro use/restrictions Medications: what is the person receiving and are there implications for massage treatment? What is involved in making the person comfortable: positioning and pillowing, what works best for pain S/S, ease of breathing, can’t be moved/needs to move frequently, use of elevation, etc. Any safety concerns related to positioning? Anything prohibited by medical team? Is the person up-and-down emotionally? In and out cognitively? If possible to determine, what are the person’s goals in receiving massage therapy? 3. Fatigue can be a very prominent symptom – shortened, adapted treatments often make the most sense. 4. Be prepared to be flexible and creative. The person can be quite different physically and emotionally from treatment to treatment. This can take the form of “good days and bad days.” As well, changes in health status can sometimes be gradual and sometimes sudden. ˃ What would you say are the RMT’s role and responsibilities as part of the circle of care? In general? Related to ongoing case info gathering and sharing? 5. At times, massage therapy isn’t appropriate. Sometimes the person just doesn’t want to be touched, or their pain level responds negatively to touch. Static holding may feel good, or simple hand/foot massage, or light back stroking, but if these are offered and rejected, or don’t feel good that day, it’s important to accept that. If there is a sudden onset new symptom, especially if you are the first one to learn of it, it may be that having the medical team evaluate it first makes best sense. 6. Cachexia: extreme thinness d/t a combination of weight loss and muscle and organ tissue catabolism. The person’s body will be more difficult to position comfortably, and decubitus ulcer risk is increased. There can be an associated dehydration concern. The person looks “sinewy” and there can be a combination of connective tissue stiffness and frailty. Stretching and mobilization must be done carefully and gradually. In addition to tearing risk, there is increased joint subluxation potential. Muscle tissue can be more easily injured with pressure and stretch. 7. Communication/Privacy Issues Related to Family/Friends: 8. RMT Preparedness Issues: ˃ In your opinion, what is involved in feeling prepared to work with palliative care patients? ˃ Is additional training needed? Mentoring?