What is palliative care
The aim of palliative care is to improve the quality of life of the person suffering from serious and prolonged illness. It prevents or treats symptoms of disease and also the side effects of the treatment.
What else does Palliative Care Include?
Apart from physical support, Palliative care also addresses the emotional, psycho social and spiritual problems that illnesses can bring up. When the person feels better in these areas, they have an improved quality of life.
Addressing physical symptoms like pain, trouble sleeping, shortness of breath, loss of appetite. nausea, vomiting etc.
Treatments may include: Medicines, Dietary advice, Physical therapy.
Psychological / Emotional Support:
Patients and their families face stress during illness that can lead to fear, anxiety, hopelessness, or depression,
Treatments may include : Counseling, Medicines
Some of the problems brought on by illness are social and financial, such as money- or job-related problems, insurance questions, and legal issues. A palliative care team may:
Some of the problems brought on by illness are social and financial, such as money or job-related problems, insurance questions, and legal issues. A palliative care team may:
Explain complex medical issues or help families understand treatment choices.
Provide or refer families to financial counseling
Help connect you to resources for transportation or housing
When people are challenged by illness, they may look for meaning or question their faith. A palliative care team may help patients and families explore their beliefs and values so they can move toward acceptance and peace.
Who provides Palliative Care?
Palliative care can be provided by all medical professionals. Some of the patients may require the services of trained palliative care physicians with experience in the relevant field.
Specialist Palliative care is delivered by multidisciplinary team comprising of Doctors, Nurses, Psychologists, Physiotherapists, Social workers and others.
Where can palliative services be provided.
Palliative care can be offered at hospitals, out patient clinics, patient’s homes and hospice.
What are the illnesses where Palliative Care is helpful
Palliative care can be appropriate for any age, any diagnosis, any stage of the disease and any prognosis. But it is generally offered for people with prolonged illnesses, such as:
Degenerative neurological conditions eg. Parkinson’s disease.
Will you need a doctor's recommendation to determine if someone is eligible for palliative care?
Yes, in most of the cases it is necessary that, the primary care physician who is treating the patient should refer him / her for supportive or palliative care.
Can Palliative care be taken along with curative treatment
Yes. Palliative Care is not in conflict with curative care. The principles of symptom control and psychosocial support used in palliative care are beneficial to the patient even when the disease is curable.
Is palliative care only for the dying patients?
Care of the dying patient (End Of Life Care) is an important part of palliative care however palliative care is not terminal care alone.Palliative care is relevant at every stage of disease particularly when it is prolonged and incurable. Palliative care may be given as supportive care when the illness is diagnosed, throughout the curative treatment, and during follow-up. If the disease becomes unmanageable and curative treatment becomes inappropriate then it becomes hospice care and towards the end it becomes terminal care.. It also provides bereavement support for the family after the death of the patient.
Is not morphine what is used for pain relief?
Morphine is only one of the drugs that are used to relieve pain. Morphine does not work in all pains. Only about two-thirds of all pains can be adequately treated with morphine. It is important that the type of pain is identified and the appropriate drugs are used. And morphine is seldom used alone. It is combined with other appropriate painkillers depending on the type of pain. If morphine is used in pains that are not morphine-responsive, it will only make the patient sedated and cause side effects.
Will morphine not cause addiction?
No, not if used properly. Medical science has clearly understood in the last few decades, that if morphine is used in doses adequate for pain relief, the incidence of addiction is very low. However, because of the possibility of addiction, it should be used over the long term with caution in non-cancer pain. In non-cancer pain, morphine or other opioids should not be first line drugs for long term relief, and when used, should be after careful evaluation, and with clear understanding by the patient.
If morphine is taken for pain now, will it become ineffective later when the pain gets worse?
No, this fear is unfounded too. Morphine can be continued as long as needed and continue to provide pain relief. Of course if the disease process and hence pain worsen, the patient’s need for morphine may increase too. But tolerance, manifesting as decreasing pain relief with continued use, is not a clinical problem with opioids. So morphine should not be reserved for the last few weeks of life. The time to start morphine is when pain demands it.
Will the patient on morphine be sedated for the rest of life?
No, certainly not. If morphine is used in morphine-responsive pain in the right dose, it does not cause sedation in the majority of cases. In fact the patient can often pursue a profession and lead a normal life while on morphine.
How about the risk of respiratory depression with oral morphine?
Used with reasonable caution, it is almost impossible to cause respiratory depression with oral morphine. The right dose of morphine is what is needed to relieve the pain. If this dose is exceeded, there are toxic signs like drowsiness, delirium and myoclonus. These serve as warning signs which prevent further consumption of the drug
What about pains that do not respond to morphine?
About one third of all pains fail to respond to morphine. Most neuropathic pains, for example, are only partially responsive to morphine. Assessment of the type of pain and evaluation of opioid sensitivity is therefore key to proper management of pain. Most of these pains can be adequately treated if we use the right combination of non-opioid analgesics and adjuvant drugs. Of course, to do this some training in evaluation of pain and management is necessary.
What role does a layman have in this? It is a medical problem, is it not?
Palliative care is not only treatment of pain and other symptoms and of disease. It is total care, incorporating emotional, and social and spiritual support. Volunteers have a large role to play in it. Volunteers can help depending on the skills they have and time available. It may be assistance with administrative matters or fund raising, but it can also be active patient care. It can include helping with nursing chores or counseling
So what is required is that , the volunteer should have the will. Is it not?
The will, certainly; but it is also essential to have the right training if one is to help people who are suffering. It is necessary to develop listening and counseling skills. It is also necessary to learn to understand needs and do what exactly is required to improve quality of life. Remember, it would be easy to hurt even with the right word at the wrong time. Many palliative care programs now conduct training programs for volunteers.
What is geriatric medicine?
Geriatric Medicine or Geriatrics is a medical speciality that focusses on helath care of elderly people.
When exactly does someone become elderly?
In India, generally people above the age of 60 years are considered as elders / senior citizens.
In many developed countries elders are divided in to three life stage sub-groups
Young Old 65-74 years
Middle Old 75-84 years
Old Old 85 years and above