People are living longer with complex medical problems owing to an increasingly ageing population and high prevalence of chronic disease.
The ED is not generally considered the ideal place to begin palliative care. The reality is that some patients presenting with an acute condition may also have a terminal illness.
Responding to the care needs of these patients is crucial to ensure the maximum amount of dignity and respect. Caring for patients who are reaching the end of their lives can be complex and there is a great deal to consider when initiating palliative care.
This involves working alongside other health professionals to provide a multidisciplinary approach to care.
ED nurses are key in the provision of high quality end of life care, as they are in a prime position to advocate and actively intervene in the best interest of the patient.
Palliative Care – Dying with Dignity: By Robin Love M.D.medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME.
Palliative Care – Dying with Dignity
Whiteboard Animation Transcript
with Robin Love, MD
Palliative care is a philosophy or approach to care for patients and families with advanced life-threatening illnesses. This includes active and compassionate care of patients who are dying in the last days to a few months of their life, but also provides care earlier in terminal illnesses especially if they have symptom management issues.
Palliative care may also be referred to as:
End-of-life care, or
Hospice may refer to a program or to a facility where care is delivered.
The goal of palliative care is to help patients live as well as possible by enhancing their quality of life and maintaining their function. Relief of physical, emotional, psychological and spiritual suffering is paramount.
The patient and family are considered the unit of care. Care is provided in the location where it is needed including home, medical offices, clinics and hospitals, as well as nursing homes and hospice facilities.
Palliative care is usually for cancer patients. It is also for those with other conditions including ALS, MS, as well as end stage renal, cardiovascular, and respiratory disease, when dying from the disease is likely within a reasonably short time.
The modern concept of palliative care recognizes the benefits of starting palliative care even during the active treatment phase of a patient's illness, as opposed to when disease-modifying agents are no longer offered.
Good communication, the importance of goals of care, symptom management skills, and whole person care with dignity are what you need to know.
Here are some general principles of good palliative care:
Clear and honest communication is a key to good palliative care. Patients want to know what is happening and what the future might hold. They have the right to know what might happen. They can choose how they want to be looked after, and how to spend their remaining time and energy.
Symptom management skills are an important part of the physicians’ role. Common symptom problems include pain, nausea and vomiting, dyspnea, bowel care, delirium, and others.
Dignity conserving care is a valuable approach. Our attitude, behavior, compassion and the dialogue we have with patients and families tells them how we care about them and how we perceive them.
Psychosocial care may include discussion of fears for the future, family support, grief and bereavement, and support with spiritual issues.
Palliative Care – Symptom Management: By Robin Love M.D.medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME.
Palliative Care – Symptom Management
Whiteboard Animation Transcript
with Robin Love, MD
Many patients with advanced life-threatening diseases have difficult symptoms that reduce the quality of their life. It's important that we do everything we can to treat the symptoms and relieve their distress.
Common symptoms include pain, nausea, dyspnea, fatigue, constipation, delirium and others. It is hard for patients to do the most important things with their remaining time if they have severe pain or are vomiting continuously.
A focused history, physical exam and investigations will help us understand the extent of their symptoms and possibly determine the underlying cause. Any investigations should be thoughtfully planned and only ordered if the result will influence our management.
The tool OPQRST can be helpful as an outline when taking a history of the symptom:
O – Onset: When did it start?
P – Provoking: What makes it better or worse?
Q – Quality: How does the patient describe the pain?
R – Region: Where is the pain?
S – Severity: From 0 to 10, with 0 being no symptom and 10 being the worst they can imagine.
T – Treatments: What have they tried and has it helped?
Most patients have more than one symptom and I find it helpful to create a problem list with a specific plan for each problem.
There are many non-pharmacological approaches that can be helpful for patients. These include physical measures such as positioning, pillows, splints, fans for airflow, heating pads, ice, massage and others. Counseling, relaxation exercises and music therapy may be helpful as well.
Pharmacological approaches are also necessary in most cases. Proper use of common medications like morphine, metoclopramide, haloperidol, lorazepam, senna, and a few others can effectively manage the symptoms in most patients. Primary care physicians should be able to manage the symptoms in the majority of their patients. Additional resources are available to assist with management of more complex patients.
What you need to know is that many patients in the last months of their life have symptoms that can be well managed. The solutions are often quite easy and straightforward. We all have a responsibility to provide this care.
Palliative Care in the Emergency Department Part 1
Palliative Care in the Emergency Department: Just Get Started
Palliative Care in the Emergency Department Part 2
What really matters at the end of life | BJ MillerAt the end of our lives, what do we most wish for? For many, it’s simply comfort, respect, love. BJ Miller is a palliative care physician who thinks deeply about how to create a dignified, graceful end of life for his patients. Take the time to savor this moving talk, which asks big questions about how we think on death and honor life.
TEDTalks is a daily video podcast of the best talks and performances from the TED Conference, where the world's leading thinkers and doers give the talk of their lives in 18 minutes (or less). Look for talks on Technology, Entertainment and Design -- plus science, business, global issues, the arts and much more.
Find closed captions and translated subtitles in many languages at http://www.ted.com/translate
Follow TED news on Twitter: http://www.twitter.com/tednews
Like TED on Facebook: https://www.facebook.com/TED
Subscribe to our channel: http://www.youtube.com/user/TEDtalksDirector
The Difference Between Care & CaringThis multi award winning video talks about a time of increased demands on our healthcare system and healthcare providers, ensuring that each and every patient and their family members are provided with compassionate care is a massive goal, but one that the staff at the Royal Alexandra Hospital are pursuing every day. Good quality care is always important, but caring for our patients is what they will really remember.
Palliative Care in Emergency Medicine
Applying some principles learned in Palliative Care to every-day Emergency Medicine practice – a guest post by Professor Ian Rogers FACEM, of St John of God Murdoch Hospital and University of Notre Dame in Perth, Western Australia
Virtual Empathy Museum
Few healthcare interventions have as much impact on a person’s physical and emotional well-being as empathy. Empathy is a basic component of therapeutic relationships and a key factor in patients’ definitions of quality care. Roll over the marked features on the homepage to navigate the site.
Díaz-Cortés, M. d. M., Granero-Molina, J., Hernández-Padilla, J. M., Pérez Rodríguez, R., Correa Casado, M., & Fernández-Sola, C. (2018). Promoting dignified end-of-life care in the Emergency Department: A qualitative study. International Emergency Nursing, 37, 23-28. doi:10.1016/j.ienj.2017.05.004
McCallum, K. J., Jackson, D., Walthall, H., & Aveyard, H. (2018). Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review. International Journal of Nursing Studies, 85, 106-117. doi:10.1016/j.ijnurstu.2018.05.011
Norton, C. K., Hobson, G., & Kulm, E. (2011). Palliative and end-of-life care in the Emergency Department: Guidelines for Nurses. JEN: Journal of Emergency Nursing, 37(3), 240-245. doi:10.1016/j.jen.2010.02.019