Palliative Care introduction

What is the term to describe a mixture of symptoms where all need to be controlled to provide a patient with a good quality of life during palliation?

Palliative care

What are some symptoms often present in palliative care?

• Pain

• Nausea and vomiting

• Constipation

• Anxiety, delirium and agitation

• Breathlessness

• Excess, noisy respiratory secretions

What is the WHO definition of palliative care?

An approach that improves the QOL of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by early identification, impeccable assessment and treatment of pain and other problems - physical, psychosocial and spiritual

What is the WHO definition of palliative care?

An approach that improves the QOL of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by early identification, impeccable assessment and treatment of pain and other problems - physical, psychosocial and spiritual

What patients may require palliation?

Patients waiting for organ transplant, with severe heart failure, severe renal failure, cystic fibrosis

What patients may require palliation?

• Provides relief from pain + distressing symptoms

• Affirms life, regards dying as normal

• Neither to hasten or postpone death

• Integrates the psychological/spiritual aspects of patient care

• Offers a support system to help patients live as actively as possible and to support family cope during the patient’s illness and their bereavement

• Uses a team approach to address the needs of patients and their families, including bereavement counsellling

• Will enhance QOL and may positively influence the course of illness

• Can be applicable early in the course of illness in conjunction with other therapies intended to prolong life e.g., chemotherapy/radiation therapy

What should occur during the patients last few days of life?

Medication review

What should be stopped in the patients last few days of life?

Any medications that aren’t providing symptom relief/causing symptoms

What is the name of treatments added to help increase the efficacy or safety of a primary therapy, usually including treatments which are added to manage symptoms of diseases/side effects relating to primary therapy?

Adjunctive therapies

What is adjunctive analgesia?

Drugs added which is not primarily used to control pain e.g., TCAs, anticonvulsants

According to NG31 what should be considered when prescribing medicines for symptom control?

• Likely cause of symptom

• Dying persons preferences alongside the benefits and harms of the medicine

• Any individual/cultural views that might affect their choice

• Any other medicines being taken to manage symptoms

• Any risks of the medicine that could affect prescribing decisions

What should be evaluated due to dysphagia occurring in palliative care?

All routes of administration

What injections does NICE NOT recommend during palliative care?

Intramuscular injections

What injections does NICE recommend for palliative care?

Subcutaneous or IV

How often does NICE recommend symptoms should be assessed?

Regularly - minimum off daily, but can happen more often in last days/hours of life

What is the type of administration for medications in palliative care not licensed for that indication e.g., for higher doses, medications in syringe drivers?

Off-label administration