Palliative Care

What is palliative care?

Palliative care is quality-of-life care for a person with a terminal condition and their family and carers.

What is the main goal of palliative care?

To help a person live well and as comfortably as possible up to the end of life, rather than focusing only on prolonging life.

Is palliative care only provided when someone is dying?

No. It can begin from diagnosis and can occur alongside active treatment.

Where can palliative care be provided?

• Home

• Aged care

• Hospice

• Hospital

• Outpatient settings.

What does holistic palliative care include?

• Medical treatment

• Pain and symptom relief

• Complementary therapies

• Equipment and services

• Counselling and grief support

• Emotional, social and spiritual support.

What are three values Australians commonly identify as important near the end of life?

• Dignity

• Avoiding pain and suffering

• Remaining independent.

Why can focusing only on prolonging life be problematic?

Modern medicine can extend life, but this can sometimes occur at the expense of quality of life.

What is person-centred care at the end of life?

Care that is based on the individual's values, preferences and wishes, rather than simply what medical professionals consider appropriate.

Why is person-centred care particularly important near the end of life?

Almost half of people nearing the end of life will need treatment decisions made, but most will not be able to make those decisions themselves.

What is advance care planning (ACP)?

The process of considering and communicating a person's values, preferences and wishes for future healthcare, particularly if they later cannot make or communicate their own decisions.

What are two key Australian advance care planning documents mentioned in the lecture?

• Enduring Power of Guardianship (EPG)

• Advance Health Directive (AHD).

Why might healthcare professionals not always know a patient's wishes?

Medical staff can be reluctant to initiate conversations about death and dying, meaning they may not know the person's values and preferences.

How can ACP benefit the individual?

It can increase satisfaction with end-of-life care, increase access to appropriate palliative care and reduce unwanted hospital visits and medical treatments. It helps healthcare decisions match the person's own preferences and values.

How can ACP benefit families?

It can reduce:

• Conflict around decision-making

• Stress

• Anxiety

• Depression.

How does ACP benefit healthcare professionals?

It provides clearer information about the person's values and preferences, supporting decision-making when the person can no longer communicate their wishes.

How can ACP reduce healthcare system use?

Care that matches a person's preferences can reduce:

• Hospitalisation

• Length of hospital stay

• ICU admissions

• Unnecessary emergency service calls and emergency department admissions.

By how much did ACP reduce ICU admissions according to the lecture?

By 37%.

By approximately how much can ACP reduce unnecessary emergency calls and subsequent ED admissions among nursing home residents?

By approximately 20%.

What physical signs may indicate that death is near in the final 24 hours?

• Mottled/blotchy skin

• Increased sleep and reduced alertness

• Decreased blood pressure

• Inability to swallow

• Loss of bladder control

• Restlessness

• Difficulty breathing

• Congested lungs.

What signs may occur in the hours before death?

• Glassy/teary, partly open eyes

• Cold hands

• Weak pulse

• Hallucinations

• Deep sleep

• Gasping or periods where breathing stops

What physical signs indicate death has occurred?

• Breathing has stopped

• No heartbeat/pulse

• Eyelids may be partly open

• Mouth may be open

• Pupils are fixed.

What is the legal definition of death generally used in Australia?

Death is generally defined as either irreversible cessation of circulation of blood or irreversible cessation of all brain function. The lecture notes that WA has no statutory definition of death.

What should be considered when caring for someone immediately after death?

• Take your time

• Turn off heaters to keep the body cool

• Straighten the body and place a rolled towel under the chin

• Wash the body

• Contact the doctor or nurse

• Contact a funeral director when ready

• Remember to care for yourself.

Who can provide generalist palliative care?

• GPs

• Nurses

• Pharmacists

• Social workers

• Physiotherapists and other healthcare professionals

• Residential aged-care services

Who provides specialist palliative care?

• Outpatient clinics

• Community/home settings

• Residential facilities

• Hospitals

• Specialist palliative care units/hospices

• Regional WA.

What proportion of primary carers are women?

67%

What is the difference between generalist and specialist palliative care?

Generalist: palliative care provided by usual healthcare professionals such as GPs, nurses, pharmacists and social workers.
Specialist: care provided by specialist palliative care teams/services when more specialised support is required.