Palliative Care Lecture Notes PDF

Palliative Care Katrina Recoche Saint Jean Pied de Port Counselling, bereavement & support services Support:  Monash University offers counselling and support services at all campuses that students can access: Phone: (03) 9905 3020  http...

Palliative Care Katrina Recoche Saint Jean Pied de Port Counselling, bereavement & support services Support:  Monash University offers counselling and support services at all campuses that students can access: Phone: (03) 9905 3020  https://www.monash.edu/health/counselling/appointments  Griefline: (03) 9935 7444  Beyond Blue: 1300 22 4636  Lifeline: 13 11 14 2 1  Objectives At the conclusion of the this session students will be able to: – Describe the definition of palliative care – Outline the principles and models of palliative care – Appreciate their professional role in support of people in the palliative phase of illness and approaching end of life The history of palliative care traditional “hospice” care; the role of religious women ‐ “hospice for the dying”: Mary Aikenhead; Australian developments; post‐war developments in medical technology rights for the dying – withdrawal from treatment. 2  The history of palliative care cont’d contemporary history – – Cicely Saunders UK ‐ 1967; – Canada & the USA – 1970’s ; – Europe – mid 1970’s – 90’s; – Australia & Asia – 1970’s & 80’s; – Africa – early 1980’s. The history of palliative care – Victoria home care, not in‐patient care; rapid expansion over a short time; community lobbying and fundraising; late 1990’s, approximately 70 services in Victoria; widespread in Australia a developing system, responding to what was missing. 3  WHO‐ Definition of Palliative Care (2020) “… is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention & relief of suffering by means of early identification & impeccable assessment & treatment of pain & other problems, physical, psychosocial & spiritual”. What does Palliative Care do? Provides relief from pain & other distressing symptoms; Affirms life & regards dying as a normal process; Intends to neither hasten or postpone death; Integrates the psychological & spiritual aspects of patient care; Offers a support system to help patients live as actively as possible until death; Offers a support system to help families cope during the illness & in their own bereavement; 4  What does Palliative care do? cont Uses a team approach to address the needs of patients & their families, including bereavement counselling if indicated; Will enhance quality of life & may also positively influence the course of illness; Is applicable early in the course of illness in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy & includes those investigations needed to better understand & manage distressing clinical complications”. Palliative Care as a Process Treatment with Curative intent Treatment with Palliative intent Diagnosis Death 5  The Palliative Approach Aims to improve QOL for individual with life limiting illness and their families by reducing suffering through early identification, assessment and treatment of physical, cultural, psychological, social and spiritual needs – Positive attitude to death and dying – Open discussion about death and dying – Not confined to end stage care – Active comfort care – positive approach to reducing symptoms and distress – Facilitates understanding through active support – Guidelines for a Palliative Approach in Residential Aged Care 2005 Palliative Care is: a philosophical approach to care; actual care models/practice. found in: – community‐based independent or institutional extension. – “acute” palliative care units, based in or near acute services; – hospice/in‐patient services; – consultancy teams – community or hospital; – developing “nurse practitioner” models. 6  Palliative Care… provides multi‐disciplinary care; provides consultation with other health practitioners; educates health practitioners formally or informally; educates family/community; promotes community awareness. Palliative care is teamwork (Taylor & Box, 1999) 7 Palliative Care Australia’s definition of palliative care (PCA, 2018)  Palliative care is person and family-centred care provided for a person with active, progressive, advanced disease, who has little or no prospect of cure and who is expected to die, and for whom the primary treatment goal is to optimise quality of life. 15 8  Interprofessional teams SPECIALIST GENERALIST  Specialist palliative care  Generalist nurses nurses, nurse practitioners  Community nurses  Palliative care physicians  GPs  Palliative care  Counsellors physiotherapists/OTs  Physiotherapists; OTs  Bereavement Counsellors  Aged care health  Loss & Grief counsellors professionals  Volunteers  Acute hospital health  Welfare Officers professionals  Social Workers 17 Elements of palliative care  Palliative care should be strongly responsive to the needs, preferences and values of people, their families and carers. A person and family-centred approach to palliative care is based on effective communication, shared decision-making and personal autonomy. 18 9  Provision of palliative care during disease trajectory (PCA, 2018) http://palliativecare.org.au/quality 19 Where is palliative care provided? Community ‐ based support Community‐based Hospital‐based People’s homes Inpatient palliative care Residential aged care beds Accommodation for Other inpatient beds those experiencing Person living (acute; sub‐acute; other) with life mental illness Outpatient services limiting Correctional facilities illness Intensive care units General Practices Emergency departments Community palliative care clinics and day Palliative care consultancy centres Hospital – based support 20 10 Palliative care service organisation and delivery (PCA, 2018) 21 Nursing careers in palliative care  Generalist nurse  Specialist palliative care nurse  Clinical nurse specialist palliative care  Palliative care nurse consultant  Nurse practitioner palliative care 22 11  References Firth et al. (2019). Establishing key criteria to define and compare models of specialist palliative care: A mixed-methods study using qualitative interviews and Delphi survey. Palliative Medicine (8):1114-1124. doi: 10.1177/0269216319858237. Jones, M. & Thistlewaite, J. (2019). Interprofessional practice in palliative care. In R.D. MacLeod & L. Van den Block (Eds). Textbook of palliative care. Springer, Switzerland, pp. 527-539. Palliative Care Aged Care Evidence [Palliaged] (2020). Models of Care- Synthesis. https://www.palliaged.com.au/tabid/4502/Default.aspx Palliative Care Curriculum [PCC4U] (2019) https://www.youtube.com/watch?v=n3z8EM81zvA Palliative Care Knowledge Network [CareSearch] (2020). Multidisciplinary teams https://www.caresearch.com.au/caresearch/tabid/1474/Default.aspx 23 12