PALLIATIVE AND TERMINAL CARE

INTRODUCTION

Palliative care is a multidisciplinary approach and specialized medical care for people with serious
illness. The goal of therapy is to improve the quality of the life. It's focused on providing patients
with relief from the symptoms, pain, physical stress, and mental stress of a serious illness.
A World Health Organization statement describes palliative care as "an approach that improves
the quality of life of patients and their families facing the problems associated with life- threatening
illness, through the prevention and relief of suffering by means of early identification and
impeccable assessment and treatment of pain and other problems, physical,
psychosocial and spiritual."
Palliative care improves the quality of life of patients and that of their families who are facing
challenges associated with life-threatening illness, whether physical, psychological, social or
spiritual. The quality of life of caregivers improves as well.

History of Palliative care in India

• The concept of palliative care was introduced in India only in the mid-1980s.
• 1975- the Government of India initiated a National Cancer Control Program.
• 1984- this plan was modified to make pain relief as one of the basic services to be delivered
at the primary health care level.
• 1980-90- the earliest facilities to deliver palliative care within cancer centers were
established- Ahmedabad, Bangalore, Mumbai, Trivandrum, and Delhi

Key factors
• The global need for palliative care will continue to grow as a result of the ageing of
populations and the rising burden of noncommunicable diseases and some communicable
diseases.
• Early delivery of palliative care reduces unnecessary hospital admissions and the use of
health services.
• Palliative care involves a range of services delivered by a range of professionals that all
have equally important roles to play – including physicians, nursing, support workers,
 paramedics, pharmacists, physiotherapists and volunteers –– in support of the patient
and their family.

Barriers to Palliative care includes:

• Lack of awareness among policy-makers, health professionals and the public about what
palliative care is, and the benefits it can offer patients and health systems;
• Cultural and social barriers, such as beliefs about death and dying;
• Misconceptions about palliative care, such as that it is only for patients with cancer, or for
the last weeks of life; and
• Misconceptions that improving access to opioid analgesia will lead to increased
substance abuse.

How is palliative care different from hospital care?

Hospital care also seeks to provide pain relief and symptom management in patients, but patients
are only eligible to receive hospital care once they have received a prognosis of six months or less
to live and elect to discontinue curative care.
At this point, a patient can transition from palliative care to hospice care. As the patient’s illness
progresses to the terminal stage, the level of care required increases. Hospice care provides a full
team of support for the patient including a nurse, hospice aide, social worker, chaplain,
bereavement specialist, and volunteers.
Patients who have been diagnosed with a serious or terminal illness should speak with their
healthcare provider about what palliative or hospice care options are available at the current point
in their disease progression. Even if the patient is not yet ready for palliative or hospice care,
becoming educated about the options will help them take an active role in planning for the future.

Why is palliative care important?

In today’s society, people are living longer than ever – even those facing serious chronic illnesses
can often enjoy a much longer lifespan than past generations thanks to advancement in the
treatment of diseases including cancer, heart disease, diabetes, and COPD. While doctors may be
successful in giving their patients a longer life, both the disease and the treatment can cause pain
and other side effects.
Palliative care is important because it gives patients an option for pain and symptom management
and higher quality of life while still pursuing curative measures. When a patient is seriously ill,
they understand the value of each day. While they still must face their illness, the support of
palliative care in controlling pain and other symptoms can make each day a more positive
experience that allows the patient to make the most of the time they have with their families.

What types of support does palliative care provide?

Palliative care includes various forms of support across multiple fronts. Palliative care supplements
your medical care. It can also provide social, emotional and spiritual support. Palliative care can
help you address practical concerns like healthcare costs and legal planning.

➢ Symptom relief
Palliative care can help improve symptoms affecting your physical, mental and emotional well-
being. Your palliative care team may deliver care directly. They may also teach you strategies you
can use every day to feel better.
Palliative care can help with:
o Anxiety.
o Depression.
o Nausea.
o Fatigue.
o Constipation.
o Pain or discomfort.
o Trouble sleeping.
o Lack of appetite.
o Shortness of breath.
o Stress.

Your palliative care team may provide:

o Tips for improving sleep.
o Cognitive exercises.
o Relaxation exercises.
o Breathing exercises.
 o Nutrition guidance.
o Exercise guidance.
o Talk therapy.
o Healing touch.
o Meditation.
o Massage.
Palliative care providers can also refer you to specialists if you need additional care.

➢ Education and advocacy

Your palliative care team can help you better understand your condition, including how it may
impact your life in the future. They can help you weigh treatment options, including what kind of
treatment you’d like to pursue. The more informed you are, the more you can make care decisions
aligned with your values, goals and preferences.
Your palliative care team can help communicate these values, goals and preferences to your other
providers so that you receive care on your terms.
➢ Social support
Palliative care specialists can help build a support network that makes coping with illness easier
for the person with the condition and their caregivers. Many caregivers face stress and strain that
can harm their physical and mental health — palliative care can ease the strain.
Your palliative care team can connect you with support groups and community resources. They
can help you communicate with family members or provide family counseling. They can also
organize friends and family members to help with caretaking responsibilities (filling prescriptions,
getting to and from appointments, etc.).

➢ Spiritual support
Palliative care may include spiritual care, depending on your beliefs and preferences. Regular visits
with a chaplain, religious leader or other spiritual advisors can be an important part of processing
your illness’s impact on your life. As a part of palliative care, spiritual care may also guide your
treatment preferences.

➢ Financial and legal support

Your palliative care team can often connect you with resources to relieve the legal and financial
stressors that often accompany having a serious illness. It can help with decision-
making surrounding