The Philosophy behind Palliative Care - Case Study Example

Heading: Personal Selling and Relationship Strategy Your name: Course name: Professors’ name: Date: The philosophy behind palliative care Palliative care has been used through the years for relieving pain in chronically ill patients. Unlike other forms of care administered to patients, palliative care does not essentially focus on treating a disease or a disorder, but on monitoring and controlling the discomfort brought about by the symptoms of the disease (Matzo & Sherman, 2006). Many terminally ill patients suffering from chronic ailments, like cancer, renal failure and diabetes may be put in palliative care to help ease their pain and make their life more comfortable. There are various issues that normally have to be addressed in patients suffering from chronic diseases. The consequence of the ailment on the patient’s way of life is paramount. Uncertainty on how the disease will progress, and how to manage symptoms are also of concern. These issues highlight the need for palliative care, and efficient communication amongst the experts handling the patient greatly improves the quality of care given (Fallon, Hanks, & Hanks, 2006). Some of the conditions that require palliative cares are end stage renal failure, cancer and AIDS. End stage renal failure The function of the kidneys is to dispose waste and maintain a particular electrolytic composition in the blood. Their inability to perform these functions results in renal failure. With the advancements made in medicine today, patients with disorders like chronic renal failure, which is degenerative and fatal, now have options, like organ transplants, or dialysis. Many of the patients that have benefited from organ transplants live normal lives and do not require palliative care (Berger, Shuster, & Von Roenn, 2006). Renal failure affects the functioning of other organs in the body, which in turn affects various whole body systems, and is thus considered a multisystem disorder. Most fatal cases involving renal disease arise from cardiovascular complications (Fallon, Hanks, & Hanks, 2006). One major challenge in renal palliative care is implementing adjustments in medication during treatment. A lot of literature exists on how to guide dose modification and schedule planning, but the fundamental guidelines pay attention to the patient’s preferred therapeutic medication, pharmacological interactions and the response of the patient to particular medication. End stage renal disease is diagnosed when the flow rate of fluid excreted by the kidneys, also known as the glomerular filtration rate, is insufficient for good health. The threshold is normally taken to be one centilitre per minute. Attention has to be paid to how drugs are administered to renal patients, for example, poor hydration can lead to an overdose, while diarrhoea and vomiting may reduce the absorption of drugs administered orally (Hoy, Lucas, & Watson, 2005). For end stage renal disease, palliative care is normally offered and used to manage the various physical and mental symptoms that the ailment manifests itself in. Cancer Cancer is the second leading cause of death in the world. Cancer patients suffer from a wide variety of symptoms through the different stages of the disease, and its treatment. In most cases, the patients’ agony could be minimised if the symptom control measures available today are practised more widely (Foley & Gelband, 2001). A lot of effort is also needed to develop new approaches of easing pain where the current measures do not do so sufficiently, if palliative care for cancer is to be improved. Research can be done through testing the results of existing care practices, coming up with new symptom control measures for end-of -life care, improving on how care is delivered to cancer patients and lastly, sharing this information with other palliative care centres. Palliative care should be given to all cancer patients, regardless of whether the goal of treatment is to cure the patient or to prolong his life Teams responsible for giving palliative care to cancer patients improve the patients’ well being, and reduce healthcare costs by conveying relevant information about the patients’ preferences and available treatment (matzo and Sherman). AIDS Palliative care for AIDS patients is not only about the relief of pain or management of physical symptoms, but also addresses numerous social issues that plague the disease (Calman, Cherny, Doyle, & Hanks, 2005). It also incorporates advanced care planning, where a patient has to make decisions concerning how he or she wishes to be cared for in the future, since his condition may render him incapable of doing so later on. There is little difference in the goals achieved regardless of whether palliation in AIDS patients is done at home or in a health care institution. In the terminal stages of life, the care given to AIDS patients becomes complicated. Even though AIDS is eventually fatal, most of the symptoms that arise from the disease are treatable, but the methods used for the treatment can be morally questionable. Patients with advanced AIDS may be too weak to handle the procedures and medication administered; raising an ethical issue on what would be the best course of treatment. Palliative care in end stage renal disease patients End stage renal failure, also known as stage 5 CKD (chronic kidney disease) is the final stage in kidney failure, when there is total, or almost total kidney dysfunction. The patient can only stay alive through dialysis or organ transplantation. Stage 5 renal patients that require palliative care include: Those that decide not to have transplants, those whom the benefits of dialysis may be outweighed by slim chances of survival, and those who may have other pre existing medical conditions that eliminate the chances of viable dialysis or kidney transplants(Stevens, 2009). Pain relief medication for these patients differs with the degree of pain experienced by the patient. Paracetamol is administered for minor pain, while fentanyl is preferred for severe pain. Other symptoms that may cause discomfort in end stage renal patients include, but are not limited to: Itching This is managed by first treating dermatitis or other possible secondary causes of itching. Additional monitoring of calcium and phosphate levels in thyroid glands and correcting any anomalies has been proven to solve the cause of itching. If the itch is severe, antihistamines can be used for relief and make the patient more comfortable. Fluid retention Due to impaired kidney function, very little fluid is purged as urine, resulting in the retention of excess fluid in the body. For patients not undergoing dialysis, diuretics, which increase the volume of fluid released by the kidneys, assist in managing this condition temporarily. Constipation This is a common symptom and is due to several factors, such as fluid restriction and side effects caused by drugs administered. A rational combination of laxatives and stool softeners can be used, although pharmacokinetics and the interaction of these drugs with others have to be monitored continuously in a patient with kidney failure. Anaemia Apart from purging urine, kidneys also produce erythropoietin. Decrease in its production is witnessed in patients with renal failure, and leads to anaemia. The major symptoms of anaemia are short breath and fatigue. For patients not undergoing dialysis, erythropoietin therapy is recommended, and the injections given can control the development of anaemia and improve the patient’s condition (Stevens, 2009). A patient suffering from end stage renal disease has to make many adjustments and restrictions to improve his condition, so as to achieve a more comfortable life. Palliative care for such a patient should be geared towards achieving this goal. 1. Fluid intake: The amount of fluid consumed is minimised, to avoid excess fluid volume in the body. Some parameters, such as daily weight, blood pressure, and hourly fluid output have to be monitored in palliative care for the purpose of evaluating the right amount of fluid to be prescribed to the patient. 2. Dietary restrictions: Foods with potassium and protein have to be minimised, and the food intake adjustments will result in weight change for the patient. Antiemetics have to be administered prior to meals to minimise nausea, and the patients’ family has to consult specialists on what foods to incorporate in the diet, and how to prepare them. Eating many small meals in a day, as opposed to few heavy ones is recommended (White, 2004). 3. Individual trauma: The patients’ mental health has to be evaluated. He should be assisted in his plans on how to cope with his condition, psychologically and emotionally, and has to be encouraged to talk about his thoughts and feelings on future plans. Palliative care in cancer patients Cancer patients have different individual needs depending on the type of cancer they are ailing from, and the treatment they are subjected to. The symptoms generally observed in patients are either physical or psychological. Except for pain, the other common physical symptoms in cancer patients are nausea, fatigue, vomiting, disability and overall weakness. The psychological symptoms observed in advanced cancer patients are normally depression and anxiety. The patient experiences this due to uncertainty about the future, and the apparent inevitability of death from the illness. Suicidal thoughts are not uncommon in advanced cancer patients due to immense pain and enormous mental distress (Calman, Cherny, Doyle, & Hanks, 2005). Patient assessment has to be done and variables monitored, for example, the patients’ mobility, alertness, bladder functions and other physiological parameters assist in analysing the progression of the disease. AIDS Quality AIDS care is dependent on various factors, like highly skilled professionals, non-discriminatory atmospheres, and easy access to care and medication. Palliative care in AIDS is important since it can significantly prolong life, and even improve the patient’s health to the point where self dependency is achieved. Unlike cancer, in which a patient’s fate is sealed once the disease progresses beyond cure, AIDS patients contract opportunistic infections which, despite being potentially fatal, can be managed and treated with antiretroviral medication. The major challenge in AIDS palliative care is the overall cost, since medication used to fight opportunistic infections is expensive, and normal antiretroviral medication has to be continued, even after a particular infection has been controlled. Another hindrance to effective palliative care is the patients’ attitude. Young people infected with HIV rarely seek palliative care, hoping that a cure will be discovered (Matzo & Sherman, 2006). Physical examinations are paramount in the assessment of HIV progression and a simple assessment of the patients’ weight and complexion can reveal how a patient is coping. A more detailed physical exam is used to monitor any opportunistic infections. The mouth may indicate bacterial or fungal infections. The skin may reveal dermatological infections, while an eye check up may confirm infections such as retinitis. The success of palliative care will depend on when and how these infections are treated. Fundamental aspects of palliative care Regardless of the life threatening illness that a patient is faced with when under palliative care, efforts to provide relief from agony and other physical or psychological symptoms are pursued with the primary intention of making the life of the patient more comfortable (Downie & Randall, 2006). The aim of palliative care is never to delay or prolong inevitable demise of the patient, but rather to add to the value of a patients’ life. Experts attending to the patient need to act as a support system not only for the patient, but also to the immediate family, since distress in such cases extend even to relatives. The burden of expensive medical care, and the psychological stress endured during the patients treatment period can have adverse effects on how the family will relate to a patient. Even though death is considered a normal transition in palliative care, the support given can sometimes influence the path that the illness takes, as witnessed many instances in AIDS patients, who can recover from potentially fatal opportunistic infections. Any life prolonging therapy available for a particular illness should always be incorporated as part of palliative care especially in the initial stages, and research done on how to ease adverse side effects that may arise from such therapy. Contradicting ideologies exist on what the precise objective of palliative care should be, since a patients’ condition is dynamic and sometimes unique, with regard to clinical parameters like response to medication, overly invasive forms of treatment and so on. While the main idea may be to increase the quality of life, some treatment methods, like chemotherapy, actually contribute to a patient’s pain and distress. It then becomes debatable whether more attention should be paid to prolonging life, or improving its quality (Downie & Randall, 2006). There is a lot of debate in palliative care on when to let a patient die. This has been allowed in medicine in instances where the risks involved in continuation of life prolonging treatment outweigh any anticipated outcome. Many situations arise when this is cannot be justified. A patient suffering from advanced renal failure cannot be left to die when there is even a remote possibility of finding a kidney donor. On the other hand, many patients with advanced renal failure have other resultant disorders that may complicate a transplant operation. This may result in the continuation of dialysis in anticipation for a transplant operation, whose success rate is questionable. The mode of payment for medical services is sometimes a major hindrance to the provision of quality health care. Most institutions will prefer regular flat payments from patients. This sometimes compromises on the value of the treatment since some recommendations made by attending practitioners, such as drug administration, x-rays and blood tests may not be carried out until payment is fully settled. Some services or treatments that may improve a patient’s condition may not be covered in the initial payment, since they may not be considered part of conventional palliative care. Supportive care for patients with advanced illnesses seems to vary a lot across geographical boundaries. The kind of illness that a patient is suffering from also influences the care accorded. Most elaborate palliative care services available are for cancer patients. This is due to the certainty of the course the disease will take once it reaches an advanced stage. Other illnesses like AIDS or end stage renal failure are not predictable, and there is little extensive research that has been done around these diseases to encourage medical practice based on evidence. Good Palliative care for patients with these ailments can be achieved through interventions such as: 1. Treatment strategies that would address the immediate symptoms, focusing mainly on pain relief and management of adverse symptoms 2. Understanding the statistics of mortalities of patients with these ailments. Studying the circumstances revolving around all deaths is important, since information relating to the well being of the diseased in the last days of life reflects on the quality of palliative care accorded. 3. Giving support to bereaved families after the demise of a loved one. 4. Continued education of experts on the best approach of care given to patients would greatly improve the quality and success of palliative care. The progress made from these interventions can be analysed using the quality of life index. The index analyses basic information on the life of the patient that tells whether the care being given to the patient has had a positive impact. Whether a patient is able to feed himself, or is pursuing some form of education or career goals reflects on his quality of life, and such are the details captured in the quality of life index. The future of palliative care Palliative care will continue to take a more central role in modern medicine, and may become an examined topic in medical courses in the future (Gamlin & kinghorn, 2001). Specialised centres providing care for chronic ailments, not only cancer, will also increase in number, as results of continued research will highlight the need for palliative care in other avenues. Research has shown that end of life patients respond more positively when a variety of interventions to control the symptoms and effects of their ailment are used. A patient may respond to only one type of treatment, or a combination of several, and the use of diverse methods to counter a particular symptom increases the chances of one method working. Irrespective of the illness, the commonly encountered symptoms are pain, difficulty in breathing and depression. Under palliative and hospice care, distress from these symptoms has to be addressed, if the patient is to be made more comfortable. Anti- inflammatory drugs or bisphosphonates are normally recommended for pain. Patients with advanced illnesses encountering problems in breathing, also known as dyspnoea, can be treated with morphine. The relaxing and sedating effect of morphine calms the patient and assists in restoring normal breathing. Antidepressants are prescribed for patients with depression, although a more holistic approach is recommended. Therapy, psychiatric care and group support all improve the mental health of the patient, and have longer lasting results in fighting depression, as compared to medication alone. Many interventions in palliative care that do not require the use of drugs exist (Matzo & Sherman, 2006). There is no general classification, but they can be grouped into five types: 1. Psychological: Concentrates on empowering the patients mind to incorporate a bio psychosocial approach in the management of symptoms, especially pain. This is achieved through patient and family education, and the adoption of relaxation techniques, pain distraction and hypnosis. Relaxation techniques, like yoga can bring comfort to a patient in agony, while distraction relieves the conscious mind of existing pain by providing diversions on the train of thought.. 2. Physiatric: This type of intervention focuses mostly on physical therapy. The body’s perception of the senses, and the overall wellness brought about by physical activity, can assist a chronically ill patient to withstand pain, and fight symptoms. Previous research has shown that pain is potentially disabling, and physical therapy can counter this (Matzo & Sherman, 2006) 3. Invasive: This intervention is used where other methods have failed. And involves the deliberate destruction of the spinothalamic tract, via an operation. This damage the nervous system, rendering it unable to transmit impulses interpreted as pain by the brain. 4. Neurostimulatory: Involves the stimulation of nerves and neurons to perceive different sensations and in the process pushing pain to the back of the patients mind. 5. Integrative- centres on harmonizing other evidence based interventions and coming up with a comprehensive plan that works for a patient. This involves working closely with the patient and understanding what works for them. Physical and biological therapies are integrated to produce a detailed non drug relief plan for patients with advanced illness. The use of drug free interventions in the management of pain and other symptoms for patients with chronic ailments is significant in that it offers relief to patients without subjecting them to the side effects that can arise from the use of drugs. These interventions need to be comprehensively integrated into palliative care. Experts need to be sensitized on the significance of adopting these non drug methods, and knowledge about the advantages of these interventions can be imparted through seminars. Education will continue taking a central role in palliative care, as with other fields of medicine. Evidence based care does not relate with every case under treatment, and there is always a need to make educated opinions on the part of the experts. Effective education is necessary if palliative care is to succeed in adding value and meaning to the life of a terminally ill patient. References Berger, M. A., Roenn, J. H., & Shuster, J. L. (2006). Principles and practice of palliative care and supportive oncology. New York, NY: Lippincott, Williams & Wilkins. Cherny, N. I., Doyle, D., & Hanks, G. (2005). Oxford textbook of palliative medicine. Oxford: Oxford university press. Downie, R. S., & Randall, F. (2006). The philosophy of palliative care: Critique and reconstruction. Oxford: Oxford university press. Fallon, M., Hanks, G., & Hanks, W.C. (2006). ABC of palliative care. London: Wiley Blackwell. Foley, K. M., & Gelband, H. (2001). Improving palliative care for cancer: Summary and recommendations. Washington, D.C: National academies press. Hoy, A., Lucas, C., & Watson, M. S. (2005). Oxford handbook of palliative care. London: Oxford University Press. Matzo, M., & Sherman, D.W. (2004). Gerontologic palliative care nursing. Missouri: Elsevier Health sciences. White, L. (2004). Foundations of nursing. New York, NY: Cengage learning. Read More