Essay on "Health in Palliative Care"

Essay 8 pages (2777 words) Sources: 10 Style: Harvard

[EXCERPT] . . . .

Strategies to reduce or prevent the negative effects of palliative care

Pain management is an important aspect of palliative care. It also has a direct impact on patient quality of life since pain is a common occurrence in terminally ill patients. To ensure successful pain management, the analgesics ladder should be followed. The ladder suggests that pain management should begin with the use of non-narcotics then weak opioids and followed by strong opioids. For a successful outcome to be achieved and to reduce the negative effects of pain management using strong opioids, the analgesics ladder should be followed. The ladder aims at delaying introduction of strong opioids to the point where it is the only available method of managing pain in the terminally ill patient.

This strategy of delaying introduction of strong opioids also helps to ensure a successful outcome of the pain management process by reducing the adverse effects associated with pain management while providing adequate analgesia for the patient's improved quality of life Pergolizzi et al., 2008

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Other than delaying opioids introduction, other approaches that can help to improve the pain management process is opioid rotation. This is where the healthcare professional switches from one opioid that is currently being administered to an alternative opioid. To be successful in this approach, the healthcare professional must be aware of a wide range of opioids and be able to convert the dosing appropriately to maintain optimal pain management Emmert et al., 2013()

Another strategy that is similar to opioid rotation is the addition of a non-opioid co-analgesic to the patient's pain management plan. This would reduce the dosing of the opioid analgesic thus reducing the potential side effects of the pain medication Narabayashi et al., 2008

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. However, similarly, the healthcare professional must accurately calculate the dosing to achieve optimal pain management for the patient Fenstad et al., 2014()

The last strategy that can be used to reduce the effect of opioids is switching the route of administration of the pain medication. Though this suggestion is based on limited data, the available studies suggest that some of the adverse effects that patients experience when they are taking opioids such as morphine orally may be relieved by changing the route of administration to for example the subcutaneous route. In two studies that were both quite small in sample size showed that when the route of administration was changed in this way, the patient experienced less nausea, constipation, nausea, and drowsiness Koffman et al., 2009()

Palliative care standards relating to caregivers in Australia

Thirteen (13) standards should be followed in providing palliative care in Australia Palliative Care Australia, 2014.

These are:

1. The patient is unique in every way, therefore, the care, decisions making, and planning that is done for the patient should take into consideration the autonomy of the patient, their family, and their caregiver. The needs and wishes of the caregiver, patient, and patient's family should be acknowledged and used to guide the decision making and care provided to the patient Palliative Care Australia, 2014()

2. The care provided should be holistic in nature. The holistic needs of the patient should be assessed and considered in planning the care to the provided. Specific strategies should be developed to address the specific gaps and needs of the patient in line with the wishes of the patient, caregiver, and family Palliative Care Australia, 2014()

3. To meets the needs and wishes of the caregiver, patient, and the family, a comprehensive assessment should be undertaken regularly Palliative Care Australia, 2014()

4. Care should be organized in such a way that it minimizes that burden that the patient, caregiver, and family bears Palliative Care Australia, 2014()

5. According to the patient, caregiver, and family needs, the caregiver should be proved with available information, support and guidance in their role as the caregiver Palliative Care Australia, 2014()

6. Palliative care should maximize the comfort of the patient, and therefore, the unique needs of the patient should be considered while preserving the patient's dignity Palliative Care Australia, 2014()

7. The palliative care service should have an appropriate and comprehensive philosophy, culture, values, environment, and structure to provide appropriate care Palliative Care Australia, 2014()

8. In case of need for information and support services, or bereavement care, formal mechanisms should be put in place to ensure this is available to the patient, caregiver, and their family Palliative Care Australia, 2014()

9. The palliative care process should build the capacity of the caregiver through fostering effective partnership and collaboration Palliative Care Australia, 2014()

10. Palliative care should be made available for all patients based on their need and disregarding their age, diagnosis, ethical background, or geography Palliative Care Australia, 2014()

11. Palliative care must be committed to improvement through research and proper management practices Palliative Care Australia, 2014()

12. Staff providing palliative care must be qualified and participate in ongoing continuing professional development.

13. Staff providing palliative care are responsible for maintaining and initiating effective care strategies for the patient, caregiver, and family.

References

BAILEY, F.A. 2008. "I Am Not Afraid of Dying. I Just Don't Want To Be There When it Happens." Medical Care, 46, 1195-1197.

BARCLAY, S. & MAHER, J. 2010. Having the difficult conversations about the end of life. BMJ: British Medical Journal, 341, 653-655.

BOYD, K. & MURRAY, S.A. 2010. Recognising and managing key transitions in end of life care. BMJ: British Medical Journal, 341, 649-652.

CAVANAUGH, T.A. 2008. Double-Effect Reasoning: Doing Good and Avoiding Evil, Oxford, Clarendon Press.

DOWNAR, J., SIBBALD, R. & LAZAR, N.M. 2010. Ethical considerations for classifying patients as 'palliative' when calculating Hospital Standardised Mortality Ratios. Journal of Medical Ethics, 36, 387-390.

EMMERT, M., POHL-DERNICK, K., WEIN, A., DORJE, F., MERKEL, S., BOXBERGER, F., MANNLEIN, G., JOOST, R., HARICH, H.-D., ROLAND, T., CHRISTOF, L., NEURATH, M.F., HOHENBERGER, W. & SCHOFFSKI, O. 2013. Palliative treatment of colorectal cancer in Germany: cost of care and quality of life. The European Journal of Health Economics, 14, 629-638.

FENSTAD, E.R., SHANAFELT, T.D., SLOAN, J.A., NOVOTNY, P.J., DURST, L.A., FRANTZ, R.P., MCGOON, M.D. & SWETZ, K.M. 2014. Physician attitudes toward palliative care for patients with pulmonary arterial hypertension: results of a cross-sectional survey. Pulmonary Circulation, 4, 504-510.

KOFFMAN, J., MORGAN, M., EDMONDS, P., SPECK, P. & HIGGINSON, I.J. 2009. Vulnerability in Palliative Care Research: Findings from a Qualitative Study of Black Caribbean and White British Patients with Advanced Cancer. Journal of Medical Ethics, 35, 440-444.

MEIER, D.E. 2011. Increased Access to Palliative Care and Hospice Services: Opportunities to Improve Value in Health Care. The Milbank Quarterly, 89, 343-380.

NARABAYASHI, M., SAIJO, Y., TAKENOSHITA, S., CHIDA, M., SHIMOYAMA, N., MIURA, T., TANI, K., NISHIMURA, K., ONOZAWA, Y., HOSOKAWA, T., KAMOTO, T. & TSUSHIMA, T. 2008. Opioid rotation from oral morphine to oral oxycodone in cancer patients with intolerable adverse effects: an open-label trial. Jpn J. Clin Oncol, 38, 296-304.

PALLIATIVE CARE AUSTRALIA. 2014. The national standards [Online]. Available: http://www.palliativecare.org.au/standards/thenationalstandards.aspx [Accessed September 26th 2014].

PERGOLIZZI, J., BOGER, R.H., BUDD, K., DAHAN, A., ERDINE, S., HANS, G., KRESS, H.G., LANGFORD, R., LIKAR, R., RAFFA, R.B. & SACERDOTE, P. 2008. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract, 8, 287-313.

REESE, D.J. 2013. Hospice Social Work, Columbia University Press.

SAUNDERS, M.M. 2009. Indicators of Health-Related Quality of Life in Heart Failure Family Caregivers. Journal of Community Health Nursing, 26, 173-182.

TEMEL, J.S., GREER, J.A., MUZIKANSKY, A., GALLAGHER, E.R.,… READ MORE

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