Palliative Care
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Basics
Palliative care focuses on preventing and alleviating the suffering of patients (and their families) living at any stage of a life-limiting illness.
Description
- The principal goal of palliative care is to prevent and alleviate suffering—whether physical (pain, breathlessness, nausea, etc.), emotional, social, or spiritual regardless of the underlying diagnosis.
- Palliative care is an interdisciplinary approach to caring for patients and families.
- Palliative care aims to improve or maintain quality of life for patients and families despite serious illness.
- The palliative care team often helps to identify the goals of care for the patient based on their preferences and values.
- Palliative care is available for patients with serious, life-limiting illness, at any stage of their disease, with or without concurrent curative care.
- Patients and their families may access palliative care services in the hospital, rehabilitation or skilled nursing facility, and ambulatory setting.
- Hospice: In the United Sates, hospice is available for patients whose average life expectancy is 6 months or less and whose principal goal is to stay at home (including long-term care or assisted living facility), avoid hospitalizations, and forego disease-directed care with a curative intent. Unlike regular home nursing services, hospice does not require a patient to be homebound. Hospice offers backup support for patients 24 hours a day and 7 days per week.
Epidemiology
- 67% of U.S. hospitals with >50 beds reported a palliative care program in data from 2012 to 2013 (1).
- It is estimated that between 69% and 82% of those who die in high-income countries need palliative care.
Commonly Associated Conditions
Common symptoms/syndromes encountered in palliative care:
- Pain
- Chronic pain
- Neuropathic pain
- Pain from bone metastases
- GI symptoms (~60% incidence)
- Ascites
- Anorexia/cachexia
- Bowel obstruction
- Constipation and impaction of stool
- Diarrhea
- Dysphagia
- Mucositis/stomatitis
- Nausea (and vomiting)
- Consider underlying etiology and treat accordingly.
- GI causes: constipation, bowel (full or partial) obstruction, ileus, heart burn, reflux, inflammation
- Intrathoracic causes: cardiac, effusions (cardiac, pulmonary), mediastinal causes, esophageal disease
- Autonomic dysfunction
- Centrally mediated: intracranial pressure change, inflammation, cerebellar, vestibular, medication or metabolic cause stimulating vomiting center, and/or chemoreceptor trigger zone
- Consider underlying etiology and treat accordingly.
- Sialorrhea
- Xerostomia
- General medical
- Delirium (40–85%)
- Pulmonary symptoms
- Cough, chronic
- Breathlessness or dyspnea (60%): which may be due to heart failure, COPD, lung cancer, etc.
- Psychological symptoms
- Anxiety
- Depression
- Insomnia
- Skin
- Decubitus ulcer
- Pruritus
- Complex wounds (fungating tumors, etc.)
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Palliative care focuses on preventing and alleviating the suffering of patients (and their families) living at any stage of a life-limiting illness.
Description
- The principal goal of palliative care is to prevent and alleviate suffering—whether physical (pain, breathlessness, nausea, etc.), emotional, social, or spiritual regardless of the underlying diagnosis.
- Palliative care is an interdisciplinary approach to caring for patients and families.
- Palliative care aims to improve or maintain quality of life for patients and families despite serious illness.
- The palliative care team often helps to identify the goals of care for the patient based on their preferences and values.
- Palliative care is available for patients with serious, life-limiting illness, at any stage of their disease, with or without concurrent curative care.
- Patients and their families may access palliative care services in the hospital, rehabilitation or skilled nursing facility, and ambulatory setting.
- Hospice: In the United Sates, hospice is available for patients whose average life expectancy is 6 months or less and whose principal goal is to stay at home (including long-term care or assisted living facility), avoid hospitalizations, and forego disease-directed care with a curative intent. Unlike regular home nursing services, hospice does not require a patient to be homebound. Hospice offers backup support for patients 24 hours a day and 7 days per week.
Epidemiology
- 67% of U.S. hospitals with >50 beds reported a palliative care program in data from 2012 to 2013 (1).
- It is estimated that between 69% and 82% of those who die in high-income countries need palliative care.
Commonly Associated Conditions
Common symptoms/syndromes encountered in palliative care:
- Pain
- Chronic pain
- Neuropathic pain
- Pain from bone metastases
- GI symptoms (~60% incidence)
- Ascites
- Anorexia/cachexia
- Bowel obstruction
- Constipation and impaction of stool
- Diarrhea
- Dysphagia
- Mucositis/stomatitis
- Nausea (and vomiting)
- Consider underlying etiology and treat accordingly.
- GI causes: constipation, bowel (full or partial) obstruction, ileus, heart burn, reflux, inflammation
- Intrathoracic causes: cardiac, effusions (cardiac, pulmonary), mediastinal causes, esophageal disease
- Autonomic dysfunction
- Centrally mediated: intracranial pressure change, inflammation, cerebellar, vestibular, medication or metabolic cause stimulating vomiting center, and/or chemoreceptor trigger zone
- Consider underlying etiology and treat accordingly.
- Sialorrhea
- Xerostomia
- General medical
- Delirium (40–85%)
- Pulmonary symptoms
- Cough, chronic
- Breathlessness or dyspnea (60%): which may be due to heart failure, COPD, lung cancer, etc.
- Psychological symptoms
- Anxiety
- Depression
- Insomnia
- Skin
- Decubitus ulcer
- Pruritus
- Complex wounds (fungating tumors, etc.)
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