CASE 8: PALLIATIVE CARE Flashcards
(31 cards)
What approach should palliative care be focused on?
Needs-based! Not diagnosis based
Disease confers a burden of disability regardless of the condition
Prevalence of Palliative care (millions)?
What percentage have CV & cancer?
40 million require palliative care yearly
39% have CV diseases & 34% have cancer
What percentage of people who need palliative care do not receive it?
86%
Health promoting palliative care: Strategies outlined in Ottawa Charter for Health Promotion
- Education on health, dying and death
- Provide social support to individuals and communities
- Encourage interpersonal reorientation around dying and death
- Reorientate the health system toward a health-promoting approach
Purpose of Palliative care
- Pain and symptom relief
- Affirms life/dying = normal process
- Neither hasten (speed-up) or postpone death
- Psychological/spiritual patient care
- Support system to live as actively as possible to death
- Support to families during the illness & death
- Team approach to address needs of patients & their families,
- Will enhance quality of life, and may also positively influence the course of illness
Define Palliative care
A proactive management strategy for a person with an active, progressive, advanced disease who has little or no prospect of cure and for whom the primary goal is to optimise the quality of life via person & family-centered care
True or false: It can be provided early in the course of illness in conjunction with other therapies that are intended to prolong life
True
What do people want from healthcare at the end of life?
Expert care:
- Excellence in physical care
- Impeccable assessment and care planning
- Effective symptom management
- Technical competence
- Patient safety
- Supported access to senior clinicians
Person-centered care
- Respectful & compassionate
- Effective communication & shared decision making
- Teamwork
- Family involvement
- Maintaining role, meaning and identity
Optimal environment
- Clean
What are the 6 elements of the National Palliative Care Strategy (2018)
- Palliative care is person centered
- Palliative care is holistic and culturally appropriate (physical, emotional, psychological, social and spiritual & addresses cultural preferences).
- Death is recognised as a natural part of life (live as fully as possible even while approaching end of life & early planning)
- Carers are valued and supported (access to information, involvement, bereavement)
- Care is accessible and equitable (ABTSI, homeless, disabled - inclusive and responsive - everyone should have access/try to minimise barriers)
- Care is high quality, collaborative and evidence based
PEOPLE = person centred
HOLISITCALLY = holistic + culturally app
DIE = death is natural part of life
CALMLY = carers are valued
AND = accessible/equitable care
HUMBLY = high quality care, collaborative and ev based
National Consensus statement on essential elements for safe & high quality end of life care (10)
Process of care (PT GT R)
* 1. Patient centred care: patients are part of decision making about end-of-life care
* 2. Teamwork: clinicians work together to provide end-of-life care
* 3. Goals of care: clear goals improve the quality of end-of-life care
* 4. Using triggers: triggers identify when patients need end-of-life care
* 5. Responding to concerns: clinicians get help to rapidly respond to patient suffering
Organisational pre-requisites (P ES ES)
* 6. Leadership and governance: policies and systems for end-of-life care
* 7. Education and training: clinicians have the skills and knowledge to provide end-of-life care
* 8. Supervision and support: clinicians providing end-of-life care are supported
* 9. Evaluation and feedback: the quality of end-of-life care is measured and improved
* 10. Supporting systems: systems align with NSQHS standards to improve outcomes
Under the Palliative care service development guidelines (2018) - what are the three levels?
- Complex and persistent (a minority of people)
- Intermediate and fluctuating (may benefit from involvement from time to time from specialist palliative care)
- Straightforward and predictable.
What is integrated-coordinated palliative care?
Right care ie person-centred
Right place (across settings ie at home, community - good integration so people can move seamlessly between these)
Right time - responsive to whereever that person is in their disease trajectory
Case Mr Le: Cancer SOB on exertion & leg oedema. Consequent mobility difficulties.
Strategies from Physio?
- Odema management eg elevation/gentle active movement/ compression
- Strengthening to aid in transfers/getting out a chair & task-specific training, mobility aids, etc
- Breathlessness strategies eg energy conservation, exercise for cardiovascular fitness, breathing techniques (may increase capacity to part-take in exercise)
Case: Peter - prostate cancer - sudden onset of lower limb weakness/pins and needles & severe LBP. MRI = spinal cord compression.
Who in the MDT team can be involved?
Psychosocial team
- Loss of function = grief type reaction. Carer may be anxious about managing.
Nurses
- Monitoring pain, plans to ensure pressure area care and continence management whilst bed bound.
Physio
- Mobility, functional exercise, etc
OT
- Assess functional capacity for ADL’s & adaptive equipment. Address cognitive and fatigue issues.
Social worker
- Link to community support and services
Dietician
- Support maintenance of energy levels and prevent muscle wasting
Role of physio in Palliative care
- Physiotherapy helps patients to move through life and its aim in palliative care is to maximise the quality of life of the patient
- Physiotherapy helps the carer/s understand how they can help
Palliative Physio Assessment tools
RUG-ADL: screening to assess how much assistance is needed for bed mobility, transfers, etc (> 18 = more assistance)
- ONTARIO/FRAMP = falls screening
Lymphoedema = girth measurements
BORG = breathlessness
Goal setting
1. Praise every achievement…
2. Be prepared to …. treatment
3. May be impossible to set …. goals
4. Goals should not be …. based
- No matter how small
- Regress
- Long-term
- Progression
What are 5 key areas that Physios manage in palliative care
- Mobility: Ax walking & transfer, maintain mob, prescribe aid, exercise prescription/falls prevention
- Pain management - positioning, encourage activity timed with meds, educate patients/carers, passive: TENS/heat or cold therapy & massage
- Falls prevention - home modifications, fall prevention, etc
- Resp management: breathing exercise, planning activities to energy conservation, relaxation techniques, manual techniques eg huff
- Lymphoedema - exercise, education and skin care, manual drainage eg massage, bandaging/pressure garments
Medicines can be used across all phases - what are these?
Diagnostic
Curative
Disease management
Palliative care
Terminal Phase
What are the 4 main meds used at any point?
What is solely used in the terminal phase?
Opioids, benzodiazepines, anti-psychotics & antiemetics
Anticholinergics = only in terminal phase
Opioids: what do they treat & what are the implications for physio
Pain & breathlessness
- Causes sedation and drowsiness → reduced participation in physio
- Risk of respiratory depression → monitor breathing
- Constipation → discomfort during movement
- Increased falls risk due to dizziness/confusion
Benzodiazepines: What do they treat and what are the implications for physio?
Anxiety/restlessness & dyspnea
- Causes sedation and reduced attention → harder to engage in therapy
- Increased falls risk
Corticosteroids: what do they treat?
Inflammation-related pain (nausea and appetite loss)
Antiemetics: what do they treat and implications for physio?
Nausea and vomiting
- Headache, dizziness, confusion
