The Line of Healthcare: Palliative Care - Essay Example

Palliative Care Table of Contents Introduction 3 Critical Analysis of the Case 4 Conclusion & Recommendation 8 Bibliography 14 Appendices 16 Introduction Palliative care is that line of healthcare, which helps in improving the span of quality life of patients facing problems for life threatening diseases in any stage through early identification, immaculate assessment and treatments of pain. Palliative care is effective in providing care as well as treatments for patients having limited life span or a chronic disease, which has a chance of reoccurring or has a chance to be a cause of a prolonged suffering for the patient in order to relieve sufferings (ICSI, 2013). The case is referred to an adult aged 71 years suffering from a severe disease i.e. Advanced Squamous Carcinoma of the Left Maxilla and Cervical Lymph node Metastases. The lady has already undergone a palliative radiotherapy of the tumour in the maxilla and cheek. The present situation of the lady points towards the fact that there was no obvious development of her state from the previous condition. Rather there has been a further deterioration in the health of the patient. It was observed that the ulcer has become large, necrotic and spread out in the mouth of the patient. In this respect, the conditions of the patient are identified to be more critical as compared to previous health state. The deterioration of health conditions and prevalence of the disease were causing huge pain to the patient. Subsequently, her son decided to put her under the palliative care of the hospital owing to her deteriorating general conditions. The essay elaborates on the critical analysis of the case with special emphasis on the given situation and the possible palliative care that could assist in relieving the lady from her present situation. The future efficient palliative care that should be considered to develop the present situation of the palliative care through proper application of guidelines in order to prevent further deterioration of the health condition of the patient. Critical Analysis of the Case According to the case scenario, the 71 year old patient is observed to be suffering from severe disease i.e. the maxilla and cheek tumour. The lady has already been treated with a palliative radiotherapy treatment. The palliative radiotherapy is usually done to relieve the pain of patients suffering from the bone metastases or any other incurable diseases (Zhu, 2012). Since, the disease is observed to be less responsive to curative treatment, palliative treatment is used to enhance the quality life of the person through relieve of suffering. Considering the incurability aspect of the disease, the lady was treated with the palliative radiotherapy initially, so that the severity of the disease could be minimised and she can lead a quality life for a larger life span. However, it has been observed even after providing the palliative radiotherapy the patient showed very less or no evidence of improvement. Rather the patient has been observed to be suffering from the side effects of the palliative radiotherapy. The new development in her condition made it evident that the disease has further deteriorated and increased the patient’s sufferings (Hung, 2007). It has been largely observed that the practice of the principles of the palliative therapy is constrained in different spheres. In this respect, palliative radiotherapy is required to be provided on the basis of its principles. The principles of palliative radiotherapy signify that each patient should be observed separately before applying any palliative radiotherapy especially when the diseases are of incurable nature (Mackillop, 1996). Palliative care has been successful in providing the patient with a better span of quality life but there have been enormous evidences of people suffering from the side effects of radiation. Similarly, in the referred case, it has been observed that the lady was possibly suffering from the side effects of the two rounds of the palliative radiotherapy. The side effects resulted in the growth of the ulcer spreading in the mouth and have lead to necrosis of the tissues (Kim & et. al., 2007). Parallel to the above the general condition of the patient, it has also been observed that the patient conditions has been deteriorating from her previous state. Palliative care is also needed to be further provided in order to mitigate the extent of pain that she has been experiencing from the side effect of the radiotherapy. Since, the impending effect of the disease could not be reverted, the only help that could be provided to the patient is to relieve her of the pain she is suffering. Moreover, palliative care is not limited only by providing quality care to the patients suffering from the endemic diseases. Patients are identified to be facing both internal as well as external issues in a care setting. Patients face internal issues owing to different factors that include cultural issues and end of life issues among others. In this context, the branch of palliative care has been efficiently providing effective physical, social as well as psychological support to the patient. The psychosocial requirement of ailing patients has been identified to be a major issue for the well-being of the patient (Onyeka, 2010). The distraught psychosomatic states are common among patients suffering from cancer. Subsequently, it has been also observed that the prolonged suffering also leads to the increase in the need of psychological support for the patient suffering. It has been identified that the people suffering from cancer have also been suffering from the Post Traumatic Suffering Disorder (PTSD). The concerns including fear of recurrence, concerns about body image and sense of vulnerability among others lead to the development of stress amid patients. However, the palliative psychological care is not the sole requirement for patients but is also required to be offered to the family members for better psychosocial support (Adler & Page, 2008). Consequently, family members of patients suffering from incurable diseases also get affected through psychological and physical stress owing to the severity of the disease and care provided. Family members of patients treated with palliative care are recognised to be affected by the challenges of incurable diseases. The family members of patients have to manage physical as well as mental stress and practical difficulties on day-to-day basis. Family members along with the patients have to experience dampening psychosocial strength owing to communicational difficulties, loss of temper and burden of prolonged sufferings (Kristjanson & Aoun, 2004). Cancer is a life threatening disease and accordingly, the family members of patients should be also offered with emotional as well as social support while providing treatment to patients. The cancer centres design appropriate palliative care unit to provide enhanced care and treatment services to patients suffering from life threatening diseases. Comprehensive palliative care includes physical, emotional as well as practical supports in order to meet the requirements of patients. The present case study suggests that the family members of the lady have also been suffering with her. The concern of the son to mitigate his mother’s ailment could be identified from his apprehension to avail a palliative care. In this respect, the son of the patient is required to be provided with better emotional as well as physical support in order to minimise stress (NCI, 2010). Owing to the huge amount of emotional requirement of the patient, the more involvement of the family members of the patient should be incorporated in order to improve her mental strength. The present operational efficiency of the patient should be monitored and any further degradation of the same should be reported immediately. Proper coordination with the healthcare providers must be maintained to enhance the efficiency of the healthcare facilities, so that her ailments are minimised. Symptoms should be managed as per the standard scales that are maintained in the healthcare centres offering palliative care. The identification of the needs of the patient at the different levels of the care and medication phase is required to be adhered. While providing proper palliative services the cultural and the emotional background of the patient should be kept in mind (National Institute for Clinical Excellence, 2004). The condition of the lady referred in the case has been deteriorating in a rapid manner form her previous state. Hence, the healthcare providers should conduct proper tests before providing her with any further radiotherapy treatments. It could be observed from the fact that the patient is of 71 years of age, which might act as a severe backlog due to the weak immune system of the patient. It suggests that the healthcare providers should be taking a note of the age of the patient before providing any kind of palliative care (National Institute for Clinical Excellence, 2004). In palliative care, patients are also identified to be facing with different external issues owing to national health issues and care setting services among others. The institute of medicine has instructed the National Cancer Policy Board to better equip the palliative care units to enhance their new and existing palliative care practices through collaboration and pilot testing centres (National Academy Press, 2001). Based on the case scenario, the patient is required to be offered with appropriate health care policies and services for better intervention and treatment of her. In this context, the patient on being admitted to the palliative care will be offered with early identification, treatment and impeccable assessment services for better symptomatic management and medication. Correspondingly, the patient and care givers are required to provide treatment as well as medication services through effective decision making and psychosocial support (Simon II & Jones, 2013). The only care that could be possible to the patient is to reduce the pain caused by such disease by providing palliative care. Palliative care units have to follow an elongated level of procedure of treatment in order to provide effective care as well as medication services. The physical care needs an immediate change in the present set of medication that is being provided to the lady. The concerned patient in the case has been observed with a severe deterioration in her health due to side effect of the palliative radiotherapy. Special monitoring should be undertaken to prevent any further deterioration from the present state. The general health condition has simultaneously been decreasing and accordingly, palliative care unit should monitor the progression of the health condition on a regular interval. Proper care should be taken with regard to the clinical development that should be implemented (Province of British Columbia, 2013). From the overall observation of the situation, it has been recognised that the patient was suffering from Advanced Squamous Carcinoma of the Left Maxilla and Cervical Lymph node Metastases. Accordingly, she was provided with palliative radiotherapy treatment. However, the patient has suffered from the side effect of the palliative radiotherapy provided to her previously. The present therapy that she should be undergoing is prevention from any other deterioration of her present state. Moreover, the pain the patient has been suffering presently due to the palliative radiotherapy should be immediately mitigated for reviving her health conditions and relieve sufferings. In this considering, the prime motive of the palliative care unit should be majorly focused on monitoring the patient continuously in order to prevent the patient’s health degradation from the present state. (BMJ, 2010). Conclusion & Recommendation The palliative care unit should be observing the potential reversible causes that could be identifiable from the deteriorating health conditions of the patient. The possible symptoms of the cancer should be observed, which should be kept in mind at the time of monitoring the patient and develop suitable caregiving technique on the basis care as well as medication required. Continuous monitoring of the patient through planned review of the patient’s history might assist in observing the progress of the patients. Improved care should be provided to the affected area to minimize the effect of the spread of the disease and pain of the patient that she is suffering (NHS, 2014). The patient has been suffering from the side effects of the radiotherapy. According to Gill & Duffy (2010), the care provided to cancer patients has been observed to be very critical, as palliative care system requires effective communication and counselling skills. Moreover, nurses require special training on providing psychological as well as social care to the patient in order to minimise stress (Gill & Duffy 2010). Coulter (2007) suggests that the disclosure of information is the foremost requirement to enhance the standard of palliative care provided to the patient. Information should be provided to the patients about reconfiguration and service development of the care giving agencies to enhance the effectiveness of care (Coulter, 2007). WHO (2008) observes that palliative care meets the need of all patients requiring the relief from the symptoms by providing special care meeting emotional, spiritual, social as well as economic requirements. Proper planning and implementing the interventions based on the patient health status and information might assist in offering appropriate care and treatment facilities (WHO, 2008; National Institute for Clinical Excellence, 2004). While dealing with the patient in the palliative care, special concern should be taken in observing that the health conditions of the patient depict certain progression. However, in the present case, the patient has been observed to be suffering from the side effects of the palliative radiotherapy provided for the treatment of her incurable disease. The patient presently needed to be offered with special care, so that the further spread of the disease could be prevented and the immediate medication could be provided in order to relieve her from the present ailments. The cancer causes being incurable and accordingly, proper palliative care should be undertaken with the aim of preventing further deterioration of the patient suffering from the adverse effect of the disease and treatment side effects. In this respect, the patient in the palliative care should be diagnosed or intervened by specialist palliative care team, so that appropriate care and treatment services are offered in order to relieve her pain or suffering after the palliative radiotherapy (National Academy Press, 2001). In this respect, palliative care is required to ensure that treatment as well as medication services are offered on the basis of certain principles, so that effective care can be offered. References Adler, N. E. & Page, A. E., 2008. Cancer Care for the Whole Patient. National Center for Biotechnology Information. [Online] Available at: http://www.ncbi.nlm.nih.gov/books/NBK4015/ [Accessed July 8, 2014]. BMJ, 2010. Spotlight. Palliative Care beyond Cancer, Vol. 341, pp. 1-20. Coulter, A., 2007. Evidence on the Effectiveness of Strategies to Improve Patients’ Experience of Cancer Care. Cancer Reform Strategy Patient Experience Working Group, pp. 1-31. Gill, F. & Duffy, A., 2010. Caring For Cancer Patients on Non‑Specialist Wards. British Journal of Nursing, Vol. 19, No. 12, pp. 1-7. Hung, W. K., 2007. Palliative Radiotherapy and Palliative Chemotherapy. HKSPM Newsletter, Iss. 1 & 2, pp. 1-4. ICSI, 2013. Palliative Care for Adults. Health Care Guideline, pp. 1-82. National Academy Press, 2001. Improving Palliative Care for Cancer. Institute Of Medicine, pp. 1-8. Kim, Y. Z. & et. al., 2007. Radiation-Induced Necrosis Deteriorating Neurological Symptoms and Mimicking Progression of Brain Metastasis after Stereotactic-Guided Radiotherapy. Cancer Res Treat, Vol. 39, No. 1, pp. 16-21. Kristjanson, L. J. & Aoun, S., 2004. Palliative Care for Families: Remembering the Hidden Patients. The Canadian Journal of Psychiatry, Vol. 49, No. 6, pp. 1-7. Mackillop, W. J., 1996. The Principals Of Palliative Radiotherapy: A Radiation Oncologist’s Perspective. Supplement of the Canadian Journal of Oncology, Vol. 6, Iss. 1, pp. 1-7. NCI, 2010. What Issues are Addressed in Palliative Care? Palliative Care in Cancer. [Online] Available at: http://www.cancer.gov/cancertopics/factsheet/Support/palliative-care [Accessed July 8, 2014]. National Institute for Clinical Excellence, 2004. Supportive and Palliative Care Services for Adults with Cancer. Understanding NICE Guidance – Information for Adults with Cancer, Their Families and Carers, and the Public, pp. 1-4. National Institute for Clinical Excellence, 2004. Improving Supportive and Palliative Care for Adults with Cancer. Guidance on Cancer Services, pp. 1-30. NHS, 2014. Symptom Control in the Last Days of Life. Palliative Care Guidelines: Last days of life, pp. 1-3. Onyeka, T. C., 2010. Psychosocial Issues in Palliative Care: A Review of Five Cases. Indian Journal of Palliative Care, Vol. 16, No. 3, pp. 123-128. Province of British Columbia, 2013. Guidelines & Protocols. Palliative Care for the Patient with Incurable Cancer or Advanced Disease. [Online] Available at: http://www.bcguidelines.ca/pdf/palliative1.pdf [Accessed July 8, 2014]. Simon II, C. B. & Jones, J. A., 2013. Palliative Care for Patients with Locally Advanced and Metastatic Non-Small Cell Lung Cancer. Annals of Palliative Medicine, Vol. 2, No. 4. WHO, 2008. Cancer Control Knowledge into Action. WHO Guide for Effective Programmes, pp. 1-51. Zhu, Y. 2012. Palliative Radiotherapy for Painful Bone Metastases: Short-Course or Long-Course? Annals of Palliative Medicine, Vol. 1, No. 1. [Online] Available at: http://www.amepc.org/apm/article/view/46/33 [Accessed July 8, 2014]. Bibliography Luebbert, K., & et. al., 2001. The Effectiveness of Relaxation Training In Reducing Treatment-Related Symptoms and Improving Emotional Adjustment in Acute Non-Surgical Cancer Treatment: A Meta-Analytical Review. Psycho-Oncology, Vol. 10, pp. 490–502. Macmillan Cancer Support, 2012. Improving Cancer Patient Experience. A Top Tips Guide, pp. 1-90. Rehse, B. & Pukrop, R., 2003. Effects of Psychosocial Interventions on Quality Of Life in Adult Cancer Patients: Meta-Analysis of 37 Published Controlled Outcome Studies. Patient Education and Counseling, Vol. 50, pp. 179–186. Appendices Palliative Care for Adults Source: (ICSI, 2013) Read More