Palliative Care For Non-malignant Conditions - Assignment Example

?Running Head: PALLIATIVE CARE FOR NONMALIGNANT CONDITIONS Palliative Care for Nonmalignant Conditions of the Under the guidance of University APA format Date of submission: Word Count: Contents Page 1. Introduction- 3 2. Overview of the needs of people with non-malignant conditions for palliative care-3 3. Critical analysis of current provision of specialist palliative care services-5 4. Critical review of other service models which have been or could be developed to meet the palliative care needs of people with non-malignant conditions -7 5. Conclusion-9 Palliative Care for Nonmalignant Conditions 1. Introduction Certain incurable conditions like advanced malignancy and end-stage organ diseases are a challenge to health professionals like nurses for several reasons. Besides instituting treatments to manage their symptoms like pain, the nurses also need to take care of other aspects like emotional support, spiritual care and psychosocial interventions (Arolker and Johson, 2007). Patients who are in terminal stages of life need to be managed in a holistic manner keeping in mind the emotional distress they are going through. Such a care is known as palliative care. Extension of palliative care services to all patients, including those suffering from non-malignant conditions is a much discussed topic in many countries all over the world. Infact, there is a lot of pressure among health service circles for the provision of palliative care to patients based on their need rather than diagnosis. However, at the same time, there is paucity of practical skills and information as to how support must be provided to patients with non-malignant diseases (Cochrane et al, 2008). In this essay, a critical analysis of provision of palliative care services by those specialists providing palliative care for cancer patients will be done. 2. Overview of the needs of people with non-malignant conditions for palliative care According to the World Health Organization (2009), palliative care is “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual." Historically, palliative care services by specialists were provided to only cancer patients (Addington-Hall et al, 1998). But, actually, even non-malignant patients in terminally ill stages require palliative care services and pressure to service these patients is mounting enormously (Cochrane et al, 2008). According to Addington-Hall (1995), palliative care must be provided to patients based on the need rather than on the diagnosis. This means that even non-malignant patients who quantify for palliative services will need palliative care services. Palliative services for those with non-malignant conditions are sparse when compared with those with malignant conditions (Cochrane et al, 2008). Several needs assessments have proven that those with certain non-malignant conditions in the the long term develop some physical symptoms which burden the patients and their family members along with certain psychosocial needs that are unmet. Some such conditions include certain chronic neurological conditions like multiple sclerosis, end-stage renal disease, chronic respiratory problems like chronic obstructive pulmonary disease and chronic heart problems like dilated cardiomyopathy (Cochrane et al, 2008). The end-stage of life, when the patient and his/her family members know about the proximity to death, evokes certain feelings and emotions like rage, denial, bargaining, envy, depression and acceptance (Aranda, 2008). According to DOH (2008), "the challenge for the NHS and social care services now, is to extend this quality of care from the minority of patients (mainly those with cancer) who currently come into contact with hospices and specialist palliative care services, to all people who are approaching the end of life." 3. Critical analysis of current provision of specialist palliative care services In Europe, various National Service Frameworks or NSFs have identified the need of palliative services in other condition too (Traue and Ross, 2005). According to the NSF for Coronary Heart Disease, those with heart failure must have access to palliative care services for support and also appropriate advice. Similarly, the NSF for Renal services suggests palliative care services for end-stage renal disease patients based on their preferences and individual needs (Traue and Ross, 2005). The NSF for Long-term diseases has identified palliative care as one of the quality needs, especially for those with neurological conditions and that they must have palliative care support when they become terminally ill (Traue and Ross, 2005). Despite acknowledgment of extension of palliative care services beyond cancer care, provision of palliate care to non-malignant disease patients is not a common practice (Addington-Hall, 1995). One of the main reasons for this is that there is inadequate research in non-malignant conditions with reference to terminal stages when compared to advanced cancer (Traue and Ross, 2005). According to a consensus statement, published by the US National Institutes of Health, those with conditions like chronic obstructive pulmonary disease, chronic hepatic failure, end-stage renal disease, dementia and congestive heart failure face with several challenges during terminal stages, the most significant of which is pain (NIH, 2004). Each condition presents with different types of challenges and the most common challenge which has undergone several researches is pain. Chronic obstructive pulmonary disease is a significant cause of death and is mainly caused due to smoking. The needs of those suffering from this condition are similar to those with lung cancer (Edmonds et al, 2001) Edmonds et al (2001) conducted interviews with carers in the post-bereavement period and compared experiences between chronic obstructive lung disease and lung cancer. Both groups of patients suffered from similar extremes of suffering, however; the symptomatology were different. Those with lung cancer suffered mainly from anorexia and those with chronic lung disease suffered mainly from shortness of breath. However, those with lung cancer had better access to support service systems like district nurses and palliative care services when compared to those with lung cancer. Other distressing symptoms common to both groups were mobility limitation. It is important to offer palliative care services to chronic obstructive pulmonary disease also because; the distressing symptoms relate to quality of life and quality of life enhancement is possible only through palliative care. This aspect is evident from the study by Gore et al (2000). According to the study by these researchers, those with chronic lung disease score worse than lung cancer patients in aspects related to daily activities and also emotional, physical and social functioning of the individual. Infact, these patients were more depressed and less acceptive of their illness when compared to lung cancer patients. 4. Critical review of other service models which have been or could be developed to meet the palliative care needs of people with non-malignant conditions There has been some debate with regard to the models of hospice or palliative services for those with chronic obstructive pulmonary disease. According to a study by Classens et al (2000), it is not at all an easy task to predict disease related outcomes in chronic obstructive pulmonary disease and hence it is very difficult to meet the expectation of treatment in this disease group. With reference to heart failure, the incidence rates are infact worse than prostate cancer or breast cancer. The most troublesome symptom in heart failure is shortness of breath and that in the cancers is pain. However, social, physical and psychological issues appeared similar in both the groups. Palliative care services in chronic heart failure patients warrants evaluation of various indicators of prognosis, identification appropriate interventions that elevate quality of life and coordination of care between service providers. Infact, those with chronic heart failure require a multidisciplinary holistic approach of care, with a combination of palliative care services and acute services (Traue and Ross, 2005). According to Davidson et al (2004), complex palliative program increases the number of patients who could die at home. End-stage renal disease is another condition that merits importance in this regard. The condition is often associated with other morbid conditions like pain, nausea, lethargy, pruritus and constipation. Symptoms related to kidney failure and comorbid conditions warrants palliative care. The NSF for renal diseases has suggested that those with chronic kidney diseases die with dignity and comfort. There are 3 categories of people suffering from end-stage renal disease. They are those undergoing dialysis, those who under went dialysis for some and then discontinued it and those who opted not to go in for dialysis. The issue of provision of palliative care services for renal diseases is addressed and recognized world wide. The symptoms of end-stage renal disease and of a considerable intensity and are comparable to those related to cancer. But symptom control techniques are different for different groups. Changes from regular regimens of management have to be made because of renal impairment. There is however not much evidence as in other chronic non-malignant conditions and hence more research is warranted for evidence based practice (Traue and Ross, 2005). There is a definite acknowledgment pertaining to palliative care in nonmalignant patients, however; there is a debate as to how this aspect can be translated to practice (Dharmasena, 2011). One concern is saturation of services in view of longer course of these diseases and a trajectory which cannot be projected appropriately. Also, palliative per se for cancer patients too is not uniform (Traue and Ross, 2005). According to Field and Addington-Hall (1999), there are basically 5 barriers pertaining to extension of the existing malignant palliative care services to non-malignant patients requiring palliative care and they are skills of the specialists delivering palliative care, difficulties in identifying candidates who are appropriate to avail palliative care services and opinions of those who are already availing the services, implications pertaining to resources and also vested interests of various parties in the health care services. 5. Conclusion Thus, despite acknowledgment of the need for palliative care services for those with nonmalignant conditions, provision of palliative care for these conditions is poor, sparse or limited by several barriers. Those with nonmalignant conditions have symptoms comparable to cancer patients and palliative care is necessary to elevate their quality of life and allow them to die with dignity. The most appropriate candidates to provide specialists services for this group of people are those who have expertise in providing palliative care for cancer patients. References Aranda, S. (2008). The cost of caring. Surviving the culture of niceness, occupational stress and coping strategies. Payne, S., Seymour, J., and isigleton, C. (Eds.). palliative care nurisng: Principles and practice for evidence (2nd ed.) (pp.573- 590). Berkshire: Opne University Press. -Addington-Hall, J., Fakhoury, W., McCarthy, M. (1998). Specialist palliative care in nonmalignant disease. Palliat Med., 12(6), 417-27. Addington-Hall, J. (1995). Reaching Out: Specialist Palliative Care for Adults with Non-malignant Disease. London: National Council for Hospices and Specialist Palliative Care Services. 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