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Designed to make sure the patient is comfortable and pain-free End of Life Palliative Care enables the patient to function through the end stages of a terminal illness. The process includes medication, alternate treatments such as chemotherapy and radiation therapies. Palliative Care is not only for pain control but also to assist the patient in dealing with the other treatments that come with the dreaded terminal disease.
Palliative care as seen today is fairly new, although hospice care has been around since the 19th Century. The goal is to allow the patient to die in an environment that will be comfortable, familiar and with loved ones.
“Patients and families often don’t think about it until it’s too late for them to benefit from it; that’s the problem, ” says Diane Mayer, MD, and director of the center for Advance Palliative Care (CAPC) in NYC.
“You matter because you are you. You matter to the last moment of your life and we will do all we can not only to help you die peacefully but to live until you die”
(Hospice Care Philosophy)
End of Life Palliative Care
End of Life: a term to describe medical care for patients with terminal illnesses or conditions that have become advanced, progressive and incurable.
Palliative Care: is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness (Wikipedia).
To understand End of Life Palliative Care you must first understand that this is an approach to improve the quality of life of not only the patient but also the families. It not only is to alleviate the pain but also the symptoms associated with treatments
Although a relatively new field in medicine, palliative care has a very long history in several forms. Beginning with the 4th century hospice was originally a place of rest for travelers and, then progressed into a hospice for the dying in the 19th century by a religious order.
In the last decade palliative care has become standard practice in hospitals across the country. The standard seemed to be medicated-heavily. Palliative care is aggressive symptom management, a decision-making platform for the end-of-life care. With comfort being the purpose a patient should be allowed the option. One could put it in the terms “How comfortable is the patient? Is the family able to deal with the daily stresses of either a family member who is a zombie or are they able to see the patient suffering and in pain?
Hospice and palliative represent two different aspects with a very similar philosophy. Palliative care services are provided in either an acute care hospital under the care of an interdisciplinary consultation service that consists of a team of highly trained physicians and nurses or in the comfort of the patient’s home surrounded by family.
When a patient sees a traditional physician or specialist the main concern of that doctor is to find a cure whether by surgery, medication or by clinical trials (the process of trying to find a cure for a traditionally incurable disease by using a careful predetermined mixture of different medications and monitoring the progression of disease. This process is monitored by the IRB – Internal Review Board and NIH – National Institutes of Health). When patient’s symptoms become unmanageable most physicians prescribe something to alleviate or mask the pain but this process can be dangerous if not carefully monitored. Addiction and other side effects can be hazardous. According to ______ a patient who enrolls in a hospice program is basically agreeing to forgo aggressive treatment to cure and start a treatment to preserve their comfort.
Palliative care can help a patient deal with the physical and emotional distress. Total suffering, a concept first thought up by Cicely Saunders, and now widely used. Dealing with total suffering involves a broad range of concerns, starting with treating physical symptoms such as pain, nausea and breathlessness. The treating teams are highly skilled in dosing medications to control patient’s symptoms but still be able to function. The team not only consists of physicians and nurses but also social workers, counselors and a clergy member(s).
Hospice care has grown exponentially in the United States. It went from mainly a volunteer organization to a major part of our healthcare systems. Amazingly, the focus on patient centered care and the quality of life has increased during the past twenty years. In the United States today, 55% of hospitals with more than 100 beds offer a palliative care program, and nearly one-fifth of community hospitals have palliative care programs. A relatively recent development is the concept of a dedicated health care team that is entirely geared toward palliative treatment: a palliative care team. Most specialty (oncology) facilities have a entire department dedicated to the end of life care.
In 2008 it is estimated that more than 1.45 million patients received hospice care and is the only Medicare benefit that includes pharmaceuticals, and medical equipment. A patient under hospice care will receive twenty-four/seven care if needed. The care extends to the family for up to one year following a death.
In the U.S. palliative care services can be offered to any patient without restriction to disease or prognosis. Hospice care under the Medicare Hospice Benefit, however, requires that two physicians certify that a patient has less than six months to live if the disease follows its usual course. This does not mean, though, that if a patient is still living after six months in hospice he or she will be discharged from the service.
When patients is diagnosed with a terminal disease, advanced or end stage cancer that person and the family goes through many emotions or stages. The palliative care team can help with any or all of the stages such as the shock or denial where the patient thinks something can be done or that there is a cure, or the “I’m dreaming”, “this can’t be happening to me”, denial.
The end of life is unique to each person and the goal of a caregiver is to make the final days and hours of a patient’s life as comfortable as possible.
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