Palliative care helps alleviate the distress of patients and their families through the comprehensive evaluation and treatment of physical, psychosocial, and spiritual symptoms.
While death is a part of life, it should not be feared but embraced.
Palliative care primarily focuses on anticipating, preventing, diagnosing, and treating symptoms experienced by patients with a serious or life-threatening illness, as well as assisting patients and their families in making critical life decisions.
Regardless of any diagnosis, the ultimate objective of palliative care is to enhance the quality of life for both the patient and the family.
Although palliative care, unlike hospital care, is not dependent on prognosis, as the end-of-life approaches, the function of palliative care becomes more aggressive and focuses on symptom management and psychosocial support.
Methods Of Care
The traditional medical treatment paradigm has become dichotomous, causing physicians to provide curative or aggressive treatment first and comfort care only after other measures have failed. Palliative medicine establishes objectives to alleviate suffering throughout all stages of the disease and is not limited to comfort care or end-of-life care.
In some instances, palliative care and hospice care are used interchangeably. Hospice care is a service delivery system that provides palliative care/medicine when life expectancy is six months or less and curative or life-prolonging therapy is no longer indicated.
Therefore, it is essential to note that while hospice does provide palliative care, palliative care is not hospice.
Note: The hospice service delivery system does not offer all available therapeutic palliative care modalities.
Managing Common Physical Symptoms
Patients at the end of their lives can experience extreme physical, spiritual, and psychological symptoms.
Palliative medicine aims to prevent and manage these symptoms while maximizing the quality of life throughout the dying process. Important factors for seriously ill patients include controlling pain and other symptoms adequately, preventing prolongation of the dying process, achieving a sense of self-control, discovering the meaning of life, and relieving the care burdens of family and loved ones while strengthening and completing those relationships.
As the end of life approaches, the symptom burden increases and the patient’s and family’s tolerance for physical and emotional stress decreases. At this time, palliative care interventions should take precedence, while restorative care should receive less attention.
The transition to palliative care is precipitated by the following four symptoms.
- Physical Ache
Pain is one of the most prevalent end-of-life symptoms. Unrelieved pain can cause patients and their families considerable distress and exacerbate other symptoms. Therefore, effective pain management at the end of life is essential.
Opioid analgesics are the standard of care for the treatment of moderate to severe pain in patients with advanced illness. However, the misconception that opioids induce respiratory depression and hasten mortality is a significant barrier to their use at the end of life.
However, both effects are uncommon when opioids are administered at the correct dosage.
Dyspnea, the subjective sensation of shortness of breath, is a common and distressing symptom, especially in terminally ill patients. Opioids and benzodiazepines are the most frequently prescribed treatments for dyspnea.
If scheduled or as-needed quantities are insufficient, a doctor can use continuous infusions to manage symptoms and alleviate suffering as death approaches.
The clinician must continuously evaluate the patient and make symptom-controlling adjustments.
- Restlessness
At the end of life, providers should recognize the signs and symptoms of the agitation associated with delirium.
Anticholinergics, sedative-hypnotics (e.g., benzodiazepines), and analgesics are the most frequently identified causes of delirium in the hospital setting. Typically, delirium and restlessness at the end of life are accompanied by spiritual, emotional, or physical distress, anxiety, agitation, and cognitive impairment. Treatment of terminal delirium typically involves the administration of a significant tranquilizer, such as haloperidol.
- Death Chimes
As end-of-life responsiveness declines, it becomes increasingly challenging for patients to control oropharyngeal secretions.
The death rattle of a person who is actively dying is the sound of air passing over accumulated secretions. Although not painful for the deceased, the death rattle can be distressing to hear for loved ones. The mainstays of treatment are repositioning the patient’s head and administering anticholinergics such as atropine or scopolamine.
Conclusion
Derby Home Healthcare fulfills the purpose of end-of-life by providing palliative care services to alleviate the distress of patients and their families through the comprehensive evaluation.
Derby Home Healthcare understands a patient’s symptoms can worsen as mortality approaches, necessitating more aggressive palliative care.
As comfort measures intensify, so does family support for a patient who is dying. After death has occurred, Derby’s Home Healthcare palliative care focuses predominantly on providing support to the patient’s family and assisting with bereavement.
