When a person is told they need palliative care, it can be an emotional and confronting thing for them and their loved ones. It is quite natural to feel afraid when hearing the words ‘palliative care’ for the first time, but with the right information and support the process can be made easier.
Palliative care essentially means that a person is at the end of their life, and a big focus is on keeping them comfortable so that they are able to live out their final time on this earth – with a focus on quality of life rather than counting the days.
The World Health Organisation defines palliative care as “the active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is the achievement of the best quality of life for patients and their families.”
Palliative care can seem like a scary process, but essentially it’s a support system to help a patient and their loved ones cope.
The Principles of Palliative Care
Palliative care is not simply a process that a patient undergoes in hospital by themselves. It’s a philosophy that is integrated into their overall care and the care their family receives.
- Affirms life and regards dying as a normal process
- Neither hastens nor postpones death
- Provides relief from pain and other distressing symptoms
- Integrates the psychological and spiritual aspects of care
- Offers a support system to help patients live as actively as possible until death
- Offers a support system to help patients’ families cope during the patient’s illness and in their own bereavement
Physical pain is an unfortunate part of many health conditions at the end of life stage. Although it is a common symptom, not everyone receiving palliative care support will experience pain.
Pain relief should therefore be something that includes the physical, psychological, social, and spiritual aspects of suffering.
As pain is layered and multidimensional, there is no one way of treating it. Physical pain cannot be treated separately from the psychology and anxieties of pain. And vice versa, the mental suffering cannot be addressed independently from the physical experience.
The first principle of managing pain is an adequate and full assessment of where the underlying pain is coming from. Keep in mind that patients may have more than one area of pain and different pains have different causes.
The World Health Organisation have developed three-step “ladder” for pain relief in adults, which can essentially be used in palliative care.
They recommend that pain medication should be given “by the clock” – which is approximately every 3-6 hours, rather than “on demand”.
If pain occurs, there should be prompt oral administration of drugs in the following order:
- non-opioids (aspirin and paracetamol);
- then, as necessary, mild opioids (codeine);
- then strong opioids such as morphine, until the patient is free of pain.
To calm fears and anxiety, additional drugs – “adjuvants” – should be used.
A comprehensive knowledge of the underlying pathophysiology of pain is essential for effective management. The three-step approach of administering the right drug in the right dose at the right time is supposed to be inexpensive and 80-90% effective.
There must always be a considerations given to treating the underlying cause of the pain – this could be by surgery, radiotherapy, chemotherapy, or other appropriate measures.
Where can people access palliative care?
Palliative care is provided where the person and their family wants, where possible. It is not exclusively locked into a clinical or hospital setting.
This may include:
- At home
- In hospital
- In a hospice
- In a residential aged care facility
Many people indicate a preference to die at home and making this possible often depends on several factors, such as the nature of the illness, the amount of care the person needs, how much support is available from the person’s family and whether the person has someone at home who can provide physical care and support for them.
For more information or resources visit Palliative Care Australia.
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