Palliative Care, the Management of Symptom or Symptoms - Essay Example

Palliative care defined In general terms, palliative (Latin, pallium meaning “cloak” or palliare meaning “to cloak” [see Twycross 2003, pp. 2) care is any care that alleviates pain and other distressing symptoms of illness that is incurable or unresponsive to any life-prolonging treatment – e.g., cancer, chronic progressive pulmonary disorders, renal disease, chronic heart failure and progressive neurological conditions, among others. Rather than intending to stop, delay, or reverse the progression of the disease itself or provide a cure (which is the reason for existence of curative care), palliative care specifically aims to affirm life and regards dying as a normal process. Aspiring to improve the quality of life for the patients and their families (see WHO 2009 definition), its offered services similarly include psychological and spiritual care, a support system to help the individual live as actively as possible until death, and a support group to sustain and rehabilitate the patient’s family (e.g., bereavement counseling). Although it is often associated with terminal illness, palliative care is actually applicable too even at the time of the diagnosis and in conjunction with other therapies that are intended to prolong life (Center to Advance Palliative Care 2009), such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage the distressing clinical implications of an illness (see WHO 2009). Evolving but technically different from hospice care system, palliative care makes use of team approach composed of palliative care doctors, nurses, social workers, chaplains, massage therapists, pharmacists, nutritionists and other experts and volunteers. Described as “low tech but high touch,” palliative care is concerned not with curing but with healing (see Twycross 2003, pp. 3). Holism in the context of palliative care Palliative care is patient-centered; i.e., it customizes treatment to meet the individual needs of each patient (Center to Advance Palliative Care 2009). But, more than customization of treatment, palliative care insists that each patient is to be assessed as a “whole person” with unique perceptions, beliefs and needs. On this account, palliative care extends its services even to the family of the patients, as it embraces all that is important to the patients throughout the course of the treatment (Pearce & Duffy 2005, pp. 66). Similarly, central to palliative care are the ideas that personal or inner resources of a person are as important as external ones and that there is link between the body and the mind. Holism (Greek, holos meaning entire or whole), when applied to health, implies that individuals have the potential to influence their own lives. As holistic care relates to quality of life, it is understood as individual’s subjective satisfaction with life and is affected by all the dimensions of one’s personhood – physical, psychological, social and spiritual (Pearce & Duffy 2005, pp. 64). Thus, while sickness may be caused by a virus, it has detrimental effects on people’s psychological, social and spiritual well-being. Caring then for a person back to health requires consideration of all aspects of one’s being human. For, health is more than the absence of physical disease as it is related to the concept of quality of life (WHO 2009). This concept is understandably very important in palliative care where often there is little hope of physical cure but a great benefit to be gained by dealing with other aspects of illness such a social isolation, moral angst, psychological distress and spiritual pain (Pearce & Duffy 2005, pp. 65). As holistic mode of care, palliative care still does not and cannot take the place and the role of bio-medicine model – i.e., a concept of illness as purely a dysfunction of the corporeal body (Pearce & Duffy 2005, pp. 66). For in view of the limitations of the latter model, the holistic model that is palliative care supplies what was lacking in the past for the health care professionals to see the patient as a person and not just a disease (Pearce & Duffy 2005, pp. 69). Symptom control in palliative care Clearly, symptom control in palliative care differs from what is termed as traditional approach to symptom control. We come to know more fully the former if we provide a brief sketch about the latter. The traditional approach to symptom control banks primarily on obtaining a diagnosis through a series of steps that include taking of detailed history of the patient, thorough physical examination, and laboratory investigations and radiographic analysis. Logical it may be, the traditional approach to symptom control is never sparing an already suffering patient until a complete diagnosis is achieved. This is because usually a patient is made to undergo a tiring battery of tests as the patient endures persisting symptoms. Essentially, the traditional approach to symptom control is rushing not to control the symptoms, but to cure the disease. And, since traditional approach to symptom control works for curable diseases, it is apparent that it is not suitable for palliative care (Joishy 1999, pp. 67). In contradistinction, palliative care approach to symptom control is not “cure” but “care”. It is not as exhaustive as the traditional symptom control approach, as for instance an advanced cancer patient may be too feeble to communicate. It includes spiritual care, which is totally out of the previous approach. And, palliative care approach to symptom control is participated in and taken care of by an entire palliative care team – hence, interdisciplinary (Joishy 1999, pp. 67). The physician brings in a problem-solving approach; the nursing care a first-rate patient care; the social worker supporting the patient and the patient’s family members concerning the non-medical issues that they face; a spiritual counselor addressing the patient’s unmet spiritual needs; the physical therapist helping the patient with activities of daily living; a dietitian for nutritional support; and volunteers providing company, cheer and help to the patient and the patient’s family (see Joishy 1999, pp. 68). Because palliative care is dealing with incurable illness, the palliative care team pays quick attention and addresses very urgently the symptoms (see Hanks, Roberts & Davies 2005, pp. 2130 – i.e., without expecting the patient to provide an elaborate history, performing a brief physical examination, and only after stabilizing the patient will a comprehensive assessment is performed regarding the primary diagnosis, the extent of the disease and previously provided therapies. All of these are accomplished by the interdisciplinary team caring for the patient (Joishy 1999, pp. 68). The management of symptom or symptoms At the heart of palliative medicine is symptom control. And, understandably, it is since holistic care requires that physical symptoms are controlled before the patient’s psychological, social or spiritual concerns may be dealt with (see Palliative Care Victoria 2009). Thus, it’s comprehensible that primary to symptom(s) management is symptom recognition. Fact is, “cure” in palliative care means effective symptom elimination. For, in palliative care, each symptom becomes its own distinct disease entity with its own etiology, pathogenesis, prognostic factors and response to treatment (Joishy 1999, pp. 61). Proceeding from successful symptom recognition, symptom management is accomplished by effecting different modalities of therapy as long as their side effects do not compromise the patient’s quality of life. Symptom management includes the conventional, other multi-modal and alternative therapies (Joishy 1999, pp. 68). Symptom management is largely through drugs such as opioids and non-opioid pain relievers, adjuvant drugs and topical treatments (Stoppain.org 2005). However, the use of pharmacology for symptom management is never a simple exercise of targeting a particular symptom with a specific drug. For, patients with advanced or incurable diseases are very vulnerable, and to deal with them there’s a necessity to recognize that environmental and psychological factors are variably but potentially influencing the patients’ physical welfare. For this, patients’ response to drug treatment is sometimes far from being predictable (Hanks, Roberts & Davies 2005, pp. 213). It would follow then that the treatment of symptom has to be tailored to fit each individual. Indeed, for some patients, they even need to try various kinds of treatments before they are able to balance pain relief and side effects rightly (see Stoppain.org 2005). Non-pharmacological approach to symptom management actually has more modes of treatment. Most of these are non-invasive. Simple and relatively safe non-pharmacological approaches include physiatic approach, non-invasive stimulatory approach, psychological approach and complementary/alternative approach. These techniques, in most cases, are used in addition to – and not in lieu of – other approaches to symptom management. The invasive non-pharmacological treatments include, among others, anesthesiologic approach, invasive stimulatory approach, and surgical approach (Stoppain.org 2005). Physiatric approach includes therapeutic exercise, heat therapy and cold therapy. Non-invasive stimulatory approach is specifically the Transcutaneous Electrical Nerve Stimulation (TENS), or the application of gentle electric current to relieve pain. Psychoeducational approach takes account of cognitive behavioral techniques (e.g., deep breathing, progressive muscle relaxation, imagery, meditation, biofeedback therapy, distraction, and reframing) and psychotherapy and social support. Complementary and/or alternative approach consists of – but not limited to – acupuncture and massage. Anesthesiologic approach is afforded patients with pain who fail conservative therapies. It ranges from simple to complex interventional therapies such as nerve blocks, epidural steroid injections, intraspinal drug administration, and/or trigger point injections. The approach of invasive nerve stimulation involves implantation of electrodes in the patient’s body to send a gentle electrical current to nerves in the spinal column of the brain, while surgical approach is only necessitated by cases where more conservative approaches have failed and where trained neurosurgeons and follow-up care are available (see Stoppain.org 2005). The principles underlying symptom control measures The important principles of symptom control are medical expertise, high quality nursing care, full assessment, attention to detail, regular review, ability (and energy) to listen, and communication skills (see Younge, Van Niekerk & Mogotlane 2007, pp. 215; Hospice Education Institute 1985). Many patients continue to suffer unnecessary physical distress on account of many medical personnel’s incognizance of what can be achieved. The fact is that significant control of symptoms in all patients and abolishment of these miserable symptoms altogether in great majority of them is utterly possible. The key to realize it is the presence of skillful medical care, masterly prescription of drugs and adroit use of the doctor “as a drug” (see Hospice Education Institute 1985). This means, medical professionals also need to have the skills of listening, reassuring and explaining so as to boost their patients’ confidence and morale if not to reduce their angst and insecurity. Similarly, it demands high quality nursing care that can be provided by nurses whose commitment to total care of patients and their families is honed by their education, training and experience. Nurses, then, are expected not only to be adept in identifying and assessing pain and understanding the utility of analgesics, but should equally be willing to advocate for their patients (see Hospice Education Institute 1985). Symptom control is not only dependent on medical team’s aptitude and attitude. It also rests on such proper and straightforward assessment of patients and their problems. These processes or tests needless to say are expected to be methodical and meticulous – which will only materialize when one careful listens (which breeds trust and improves patients’ compliance). With medical caregivers carefully lending an ear to the patients, symptoms are elicited and the symptoms’ significance is discovered. From which, in-depth examination of the patient may be carried out. Actually, examination of the patients is per se a powerful non-verbal message giving hint to the medical professionals’ interest over the welfare and health of the patients (cf. Hospice Education Institute 1985). References: Center to Advance Palliative Care. 2009. What is palliative care. [Online]. Available at http://www.getpalliativecare.org/whatis [Accessed 11 September 2009]. Ferguson, L., Fowler-Kerry, S. & Hain, R. 2006. Education and training.Oxford textbook for palliative care for children. In A. Goldman, R. Hain, R. & S. Oxford: Oxford University Press. Hanks, G., Roberts, C. & Davies, A. 2005. Principles of drug use palliative medicine. In D. Doyle et al. (eds). Oxford textbook for palliative medicine, 3rd ed.. Oxford: Oxford University Press. Hospice Education Institute. 1985. Principles of symptom control. [Online]. Available at http://www.hospiceworld.org/book/principles_of_symptom_control.htm [Accessed 12 September 2009]. Johnson, Miriam. 2009. The principles of symptom control. [Abstract / Online]. Available at http://www.bjhm.co.uk/cgi-bin/go.pl/library/article.cgi?uid=41618;article=hm_70_4_186_187 [Accessed 17 September 2009]. Joishy,Suresh. 1999. Palliative medicine secrets. Philadelphia: Hanley & Belfus, Incorporated. Mazanec, P. & Bartel, J. 2007. Symptoms and symptoms management. [Online]. Available at http://www.deathreference.com/Sy-Vi/Symptoms-and-Symptom-Management.html [Accessed 12 September 2009]. Palliative Care Victoria (PCV). 2009. Pain and symptom management. [Online]. Available at http://www.pallcarevic.asn.au/health-professionals/painsymptom-management1 [Accessed 16 September 2009]. Pearce, C.M. & Duffy, A., 2005. In J. Lugton & R. McIntyre, eds. Palliative care: the nursing role. London: Elsevier, Ltd., Chap. 3. Stoppain.org. 2005. Pain. [Online]. Available at http://www.stoppain.org/palliative_care/content/symptom/pain.asp [Accessed 17 September 2009]. The National Council for Palliative Care. 2009. Palliative care explained. [Online]. Available at http://www.ncpc.org.uk/palliative_care.html [Accessed 12 September 2009]. Twycross, R., 2003. Introducing palliative care. 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