Dr Raksha Kundal
WHO defines palliative care as an approach that improves the quality of life of patients – adults and children – and their families facing problems associated with life-threatening illnesses. It prevents and relieves suffering through early identification, impeccable assessment and treatment of pain and other physical, psychosocial, or spiritual issues.
There is a growing need for palliative care in India due to the ageing population and the increasing burden of cancer, cardiovascular disease, and other life-limiting diseases.
Palliative care improves the quality of life, treats the symptoms of such patients and provides needed support to the family. The primary goal of palliative care is to maximise the quality of life rather than focusing on curing the uncurable disease by addressing physical, psychological and spiritual needs. The aim is to provide symptom relief and mitigate the overall miseries of patients and their families.
Who can benefit from Palliative Care:-
- Patients with life-limiting diseases or severe illnesses like kidney failure, lung failure, heart failure, etc
- Cancer Patients with advanced or metastatic cancer for symptom management, side effects treatment, and emotional distress management.
- Elderly patients with multiple chronic diseases can benefit from managing their symptoms and addressing their psychosocial and spiritual needs.
- Children with life-limiting diseases can benefit from improved quality of life; support is also provided to their families for adaptation.
- Advanced Dementia patients can have improved quality of life as palliative care addresses pain, discomfort, and psychosocial needs.
- Family caregivers: Those caring for such patients receive support to cope with the emotional burden and challenges of caregiving.
Skills of Palliative care specialists- They are trained to manage symptoms like pain, nausea, shortness of breath, anxiety, and depression. They are also experts in managing the emotional needs of patients and their families.
Who can provide Palliative care-
Palliative care team composition can vary depending on the patient’s needs and preferences. The team aims to provide patients with holistic and compassionate care to improve their well-being in challenging times.
Trained Doctors: Palliative medicine is emerging as a separate branch. Palliative care physicians and trained doctors work closely with other specialties to provide comprehensive care to patients needing palliative care.
Anaesthesiologists: They are skilled in providing pain medications, nerve blocks, epidurals,etc. for pain management.
Nurses: Palliative care nurse is involved in the day-to-day care of such patients; these nurses are trained in symptom management and comprehensive care.
Social workers: They are an integral part of palliative care; they help patients and their families deal with practical and emotional challenges. They provide help with financial concerns.
Priests or spiritual care providers: They offer comfort and guidance to patients and their families per their spiritual needs and beliefs.
Counsellors and psychologists: They care for patients and their family’s mental and emotional well-being. It helps them to cope with the psychological impacts of illness.
Dietitians: They guide the nutritional support required by the patient to maintain adequate energy.
Home caregivers: They assist with daily activities and personal care for palliative care patients at home.
Where Palliative care can be delivered
It can be delivered in a hospital, Outpatient clinics, a hospice facility, and even at home.
Hospice Facility
A hospice facility is a particular healthcare facility where terminally ill patients can receive hospice care more supportably. They are different from traditional hospitals as the primary focus of hospice is not curative treatment but is to provide pain management, comfort, and emotional support in the final days of life. These facilities are equipped with trained staff and all amenities for such terminally ill patients.
Components of palliative care
Pain and symptom management: The main goal is to alleviate the pain and symptoms arising from disease or its treatment like nausea, vomiting, breathlessness, fatigue, etc.
Holistic care: Addresses the physical, social, emotional, psychological, and spiritual needs of the patient.
Psychological support: These patients are often distressed, have anxiety-related issues and poor emotional control, and need psychological help.
Spiritual need support and cultural sensitivity: These patients often have unmet spiritual needs. Their cultural beliefs should be respected.
Quality of life enhancement: The focus should be on improving quality of life, bringing joy to their life even during illness
Correct information and decision-making: Patients and their families are provided with accurate information and are involved in decision-making for treatment planning.
Caregiver and family support: Palliative care supports families and caregivers in managing such patients.
Social support: Palliative care provides sources of social support for family and patients through support groups, financial assistance, and companionship.
Good palliative care provides a comfortable environment, expert care to the patient, pain, and symptom management, family, spiritual, psychological, social, and emotional support. It should provide continuous and holistic care, resulting in improved quality of life.
Palliative care is often misunderstood as end-of-life care, whereas palliative care is part of end-of-life care. Patients receiving palliative care may live for years havinga good quality of life.
(The writer is Associate Professor, Department of Anaesthesia, AIIMS Jammu).