Palliative care
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Palliative care is any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease or slows its progress rather than providing a cure. It aims at improving quality of life, and particularly at reducing or eliminating pain.
The World Health Organisation (WHO), in a 1990 report on the topic, defined palliative care as "the active total care of patients whose disease is not responsive to curative treatment". This definition stresses the terminal nature of the disease. However, the term can also be used more generally to refer to anything that alleviates symptoms, even if there is also hope of a cure by other means; thus, a more recent WHO statement [1] (http://www.who.int/cancer/palliative/definition/en/) calls palliative care "an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness". In some cases, palliative treatments may be used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherapy.
The term is not generally used with regard to a chronic disease such as diabetes which, although currently incurable, has treatments that are (ideally) effective enough that it is not considered a progressive or life-threatening disease in the same sense as cancer.
Though the concept of palliative care is not new, in the past most doctors have concentrated on aggressively trying to cure patients, so that concentrating on making a patient comfortable was seen as "giving up" on them. In recent times the concept of having a good quality of life has gained ground, although many would argue that there is a long way to go yet. A relatively recent development is the concept of a health care team that is entirely geared toward palliation; this is often called hospice care.
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Hospice care goals
More than a place, hospice care is a philosophy. Hospice care neither aims to hasten death nor to postpone death. It is characterized by concern for symptom relief and promotion of general well-being and spiritual comfort for the dying. The need to maintain quality of life in of the dying (or "quality of dying") is important as life expectancy increases with a corresponding increase in the incidence of age related chronic illness. The patient and family are both the focus of hospice care, with emphasis placed upon the well-being of family caregivers as well as the patient.
Hospice history
Hospice is a relatively recent concept that originated and gained momentum in the United Kingdom after the founding of the first modern hospice, St. Christopher's Hospice in 1967. Dr. Cicely Saunders is regarded as the founder of the hospice movement. Since its beginning, the hospice movement has grown dramatically. Relatively generous Medicare reimbursement for hospice treatement has greatly increased hospice usage in the United States.
The first hospice in the United States was established in 1974.
Hospice practice
Hospice care most often occurs in the dying person's home. It is also provided in free-standing hospice units and (more rarely) within regular hospital units.
In the U.S., hospice care is provided by an interdisciplinary team consisting of physicians, registered nurses, chaplains, social workers, and, most importantly, the family. The focus of the team is to optimize the hospice patient's comfort. Additional members of the team are likely to include home health care aides, volunteers from the community, and housekeepers.
A patient is usually admiited into a hospice program if there is a reasonable expectation of death within 6 months. This does not mean, though, that if a patient is still living after six months in hospice, she will be discharged from hospice.
Opportunities for caregiver respite are one of the services hospices provide to promote caregiver well-being. Respite may be for several hours or up to several days (the latter being done usually by placing the patient in a nursing home or in-patient hospice unit for several days).
Often the patient and her loved ones may have to make a decision whether to remove life sustaining treatment (e,g., artificial nurtition, ventilators, etc.). It is a great relief for loved ones if the hospice patient has made a living will specifying what to do in the event of a terminal condition. Nevertheless, loved ones may want to consult their clergy on how their spiritual tradition views end of life care. If the loved ones do not belong to a church, synagogue, mosque, etc., they can contact the hospice organization who may have clergy on staff or relationships with pastoral organizations who can talk with the hospice patient's family.
Often loved ones are advised to stop feeding and hydrating a hospice patient near the very end of life. Withrawing food and/or water is said to have a narcotic-like effect on the body.
After a death of a loved one who was in hospice care, it is common for most hospice organizations to offer bereavement counseling to members of the deceased's family.
Board certification for physicians in palliative care is through the American Board of Hospice and Palliative Medicine.
Iis important to note that while in hospice care, a Medicare patient in the United States gives up her claims to get reimbursed for any treatment of the "terminal" condition with the exception of what the hospice considers palliative treatment. (Though a hospice patient may later opt out of hospice care.) Also, Medicare does not reimburse for what is considered custodial care.
Treatment of discomfort
Alternative medical treatments such as relaxation therapy [2] (http://jama.ama-assn.org/cgi/content/abstract/276/4/313)[3] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10390006&dopt=Abstract), massage [4] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=10851775&dopt=Abstract), music therapy [5] (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14669295&dopt=Abstract), and acupuncture [6] (http://www.jco.org/cgi/content/abstract/21/22/4120) can relieve some cancer-related symptoms and other causes of pain. Treatment that integrates complementary therapies with conventional cancer care is integrative oncology.
It is very common for hospice medical personnel to prescribe use of opoids (usually morphine) to relieve pain and breathing difficulties. Antiemtic drugs may also be prescribed for nausea.
See also
External links
- End of Life Choices (http://www.endoflifechoices.org/)
- Palliative care (http://www.aromacaring.co.uk/palliative_care.htm)
- Psychosocial Oncology and Palliative Care (http://www.uhn.ca/programs/obd/psychosocial_oncology.asp)
- Pain & Symptom Management and Palliative Care (http://www.bccancer.bc.ca/PPI/PSMPC/default.htm)
- Palliative Care (http://www.virtualcancercentre.com/asp/documents/what_is_palliative_care.asp?sPageType=palliative)
- American Academy of Hospice and Palliative Medicine (http://www.aahpm.org/)
- American Board of Hospice and Palliative Medicine (http://www.abhpm.org/)
- The National Hospice and Palliative Care Organization (NHPCO) (http://www.nhpco.org)
- The Center to Advance Palliative Care (CAPC) (http://www.capc.org)
- Hospice Association of America (HAA) (http://www.hospice-america.org/)
- International Journal of Pain Medicine and Palliative Care (http://www.pain.remedica.com)de:Palliativmedizin