Introduction
The following article observes and analyzes a number of themes and topics associated with palliative care. The report recounts the key concepts and principles that guide the appropriate use of palliative care in healthcare settings. Following this, the presence of palliative care in neurological practices is outlined, issues and advantages become prominent and the best implementation of the care is observed. Differences between hospice and palliative care are described and compared. The business components of palliative care are discussed and challenges and benefits are outlined. All these components make up the major factors that reflect the current practice of palliative care within healthcare environments.
Key concepts of palliative care
Palliative care delivery is founded on a number of concepts that are often overlooked or undervalued in general health care. First, palliative care is able to provide for patients in multifaceted care. This is because palliative care, unlike hospice care, not only promotes comfort care but may include curative intent. Similarly, patients are able to forego curative treatment, which makes palliative care very adaptable, specialized, and focused on the improvement of quality of life. Though previous practices have usually resulted in palliative care only being administered during the most severe times of a patient’s illness, this has often been contested. Most modern practices of palliative care work on the notion that symptom management, psychological support, and care planning can be viable throughout all stages of an illness. Palliative care is not only beneficial but also integral to improving the quality of life of patients regardless of the stage of their condition or illness.
Early integration of palliative care in cases of patients with cancer is becoming more frequently utilized. Such implementation is especially effective in terms of optimal clinical outcomes for patients with advanced cancer. Better mood, higher quality of life, and decreased aggressiveness had been observed among patients with late-stage cancer that had received palliative care. There was even evidence that suggested that patients receiving palliative care had lived longer than counterparts that did not receive it. Palliative care is beneficial to individuals with other chronic conditions outside of cancer. Individuals that suffer from illnesses that have a high impact on their life due to heavy symptoms can equally notice improvements in quality of life. However, palliative care has yet to become more commonly practiced among patients with obstructive pulmonary, advanced congestive, neurodegenerative, and end-stage renal diseases (Strand et al., 2013). Palliative care provides aggressive symptom management and psychological support that could greatly contribute to the quality of life of individuals with the aforementioned conditions. Patients with cancer often experience severe pain but studies show that adequate pain management and reduction are not always available. The advantage of palliative care is that it works to manage the total pain experienced by patients as leaving it untreated worsens their wellbeing and quality of life.
Many late-stage illnesses manifest a variety of non-pain symptoms including but not limited to delirium, nausea, fatigue, and dyspnea, among cancer patients. All of these symptoms affect patients physically and emotionally, often becoming time-consuming and not allowing patients to spend their last days in ways they prefer. Clinicians in palliative care utilize their experience in ways that are efficient and allow the patients and their relatives or other caregivers to not be burdened by additional non-pain symptoms. Late-stage and terminal illnesses always have a severe impact on the emotional well-being of the affected patient and their close relatives or friends. Preparatory grief is incredibly common among patients as they experience the negative emotions associated with their passing including losing functions, missing important future events, or imagining the absence of their loved ones. Overall, the psychological effects of terminal illness are incredibly complex and patients require support. Clinicians may even have to separate preparatory grief from clinical depression in order to better understand the mental state of a person.
The emotional impact of terminal illness creates a necessity for effective communication. An empathetic relationship and channel of communication between physician and patient have been linked to care satisfaction, therapy adherence, and higher health outcomes (Strand et a., 2013). The issue of communication becomes quite challenging for certain cases of terminally ill patients which require palliative care health professionals to excel in clear and meaningful exchanges with said patients. Modern palliative care is continuous even to the point at which treatment and care are ineffective, and this approach often contributes to a variety of improvements for the patient. Modern palliative care is often associated with end-of-life planning and care, but there are benefits prior to such diagnoses. The assumption that palliative care directly correlates to a lack of curative treatment is the most prevalent barrier to providing such care to many patients. Many patients that can benefit from the features provided by palliative care either fails to receive it or only receive it at a much later stage. This results in a number of drawbacks including a lack of knowledge about one’s own illness, wishes for future care, and unpreparedness. Palliative care is valuable to general health care as it has been associated with cost-saving. Due to the many deeply involved practices throughout palliative care, cost-avoidance mechanisms are engaged and allow for improved care without additional expenditure.
Appropriate utilization of palliative care
In order to better grasp the appropriate utilization of palliative care, it can be useful to observe the principles of the practice. Though there is no definitive methodology for providing palliative care, the five principles of patient and family-centered care, need assessment, use of local and networked services, evidence-based interventions, and integration and coordination of care are integral. Centering care plans on the patient and family is the initial step of any adequate utilization of palliative care. When actualized this manifests as the presence of the patient and the family in care planning, goal setting, and decision-making processes. While the patient remains the leading factor in formulating care, family or careers world as partners and aids in the procedure. This connects to a number of palliative care concepts, such as being aware of one’s own condition and having a comprehensive understanding of any ongoing treatments or care plans.
Care based on the assessment of a patient’s needs is also an appropriate implementation of palliative care. This is because such focus provides care that is conscious of the patient’s wishes and preferences. Similarly, the progression of a person’s condition throughout their palliative care is likely to cause changes to their needs. An adequate palliative care plan must account for these changes and be adaptable. Such a process would require frequent assessments, responsive modifications to plans and treatments, and effective communication with the patient, their family, or cares (Strand et al., 2013). Similarly, needs-based interventions have clinical advantages, as allowing for flexible care plans allows for easy transitions between physicians or facilities. This provides patients with more options than a continuous and non-adaptable care plan would. The patient’s condition during end-of-life situations is subject to change not only physically but emotionally and psychologically, and an appropriate care plan must account for this.
Local and networked services in palliative care refer to a process that works to provide the highest quality of service as close to a patient’s home as possible. Adequate implementation of palliative care aims to provide care to patients in spaces that they prefer, but this does mean that additional planning is required to assure that treatment is adequately implemented, equipment is available, and physicians can arrive in reasonable time frames. Due to these challenges, palliative care professionals must make clinical and logistical judgments regarding how a patient can receive all components of their palliative care. This requires health care workers to consider all potential situations in which a patient may find themselves due to their condition at their current stage in the illness. While networked services that work seamlessly in certain areas are not available everywhere, it is vital to promote such cohesive channels of communication and treatment in order to provide the best palliative care to patients residing in their homes.
Evidence-based intervention in palliative care requires it to be free of preventable harm and reliant on effective partnerships between healthcare providers and patients. Outside of immediate care, physicians should be aware of psychological and cultural factors that are associated with a patient. Meaningful data should be considered in all the decision-making processes between the patients, physicians, and family or cares. Care coordination and integration refer to seamless delivery of care throughout a health care system and the existence of an accessible interface for social care. Essentially, it represents extensive and wraparound support for individuals with complex needs. Integration can include social, psychological, and clinical support in a format that is easy to navigate and utilize. The collaborative implementation of all these principles is likely to manifest an appropriate use of palliative care that produces positive health outcomes among patients.
Utilization of palliative care in the treatment of neurology patients
A number of neurological conditions frequently include chronic, progressive, disabling, and life-liming features. Palliative care can be equally efficient in managing physical symptoms and psychological issues faced by patients suffering from neurological illnesses, though certain differences should be mentioned. Principles that are prevalent in other palliative care instances can be observed throughout neurological practices as well. First, the needs of the patients must be distinguished, in addition to the personal preferences of patients receiving palliative care; neurological patients may possess other unique needs. Following actions would require analyzing ways in which neurologists can acquire certain skills associated with palliative care as well as the integration of the practice into general neurology. The ability to need all the aforementioned goals can indicate an adequate presence of palliative care among patients with severe neurological conditions.
The key to understanding the needs of patients with neurological conditions lies in considering what kind of patients and their families would benefit from palliative care. Deductions could be based on the locations of the patients, as individuals in remote areas frequently receive disproportionately less care. This can be equally true about their access to palliative care. Other factors like economic status and social background may also play a role. Essentially, in the case those neurological departments are able to distinguish between patients that have and don’t have barriers to palliative care; it is possible to implement greater accessibility. For instance, a well-executed application of palliative care among patients with neurological conditions would not decrease care even if the benefits were questionable. Since neurologic diseases are largely incurable, this issue may arise frequently but should not reduce the palliative care that can provide patients with improved quality of life, management of pain, mental conditions, and even minimal prolongment of life.
Studies suggest that more traditional approaches to palliative care do not sufficiently address the needs of patients that suffer from neurologic diseases. As a result, greater diversification and modification of such practices are necessary in order to address these unique needs. The trajectories of life-limiting diseases in patients with neurological disease differ from those that are experienced among cancer patients. Neurological illnesses often manifest a variable disease progression accompanied by cognitive impairment, issues with communication, behavioral problems, and even motor symptoms (Boersma et al., 2014). Essentially, the severe and less predictable challenges faced by individuals with neurologic diseases do not benefit from the more understood and pattern-like trajectory of cancer progression. While many collaborative procedures of neurological treatments and palliative care recognize the need for unique care plans, further progress can be made to integrate the two practices.
The introduction of palliative care into neurological practices requires cohesive integration of specific treatments as well as the specialization of certain neurologists and other physicians. There are a number of palliative care skills that can be beneficial to all physicians, regardless of their main practice. These include the communication of bad news, advance care planning, and caregiver and nonmotor symptoms assessments. For patients with more complex or advanced conditions, it may be more beneficial to refer patients to palliative care experts whether these are care consultants, home cares, or other forms of service delivery. As such, it is vital for neurological departments to integrate or connect to palliative care specialists and groups. A completely integrated form of palliative care service would include a specialized team of physicians operating alongside neurologists.
Compare and contrast palliative care and hospice care
Palliative care and hospice have a number of similarities and differences. Hospice is defined as a form of care in which terminally ill patients receive pain management for symptoms and support in meeting their emotional and spiritual needs (Cassel et al., 2015). Both forms of care are similar in that they offer medication in order to ease pain and symptoms that reduce the quality of life. Similarly, both approaches go beyond only medical help and provide patients with support, social work services, and experts in care coordination.
Palliative and hospice care also share the prioritization of patient involvement. Both practices are able to include families and cares to the extent to which a patient prefers. Support services such as grief counseling and illness support groups are usually provided to both the patient and their family or cares. Hospices and palliative care services provide support both in-home and in other settings. These may also include hospitals or long-term care facilities.
Palliative and hospice care vary in five significant ways. Palliative care may continue curative treatment while hospices are strictly for patients that prefer to not partake in any more treatment. Similarly, palliative care services can provide patients with aggressive measures to prolong their life while hospice settings avoid such measures. This is relevant for many additional conditions, such as infections, which may be left untreated in hospice environments. This is often done in order to remain in their preferred location and avoid trips to a hospital.
Current policies reflect that only individuals with terminal illnesses are viable for palliative care, though this has been challenged more frequently due to the benefits of early integration. On the other hand, hospices include only patients that have an assumed life expectancy of fewer than six months in most settings. Medical teams are not changed for individuals receiving palliative care as they will continue to receive treatment while hospice patients are likely to no longer interact with the medical team servicing them prior. Palliative care is more frequently given intermittently, as symptoms worsen, while hospices provide ongoing care.
The business case for palliative care
As mentioned prior in the report, palliative care fosters growth in value throughout healthcare systems by enacting cost-saving techniques. The existence of palliative care inherently contributes to the financial model of healthcare as it reflects the need for specific services for demographics that include patients with terminal conditions. Without the use of cohesive palliative care services, many medical expenses experienced by patients are incredibly expensive, and self-managing all treatments can be time-consuming and unaffordable for many.
Hospitalization over prolonged periods of time that are common in end-of-life treatments of terminally ill patients can reflect poor fiscal outcomes for the hospital. The diverse nature of palliative care which can provide services in at-home or alternative settings could minimize such damages. Prolonged duration is not only an adverse effect on the financial factors of payers but can also be restrictive for hospitals that lose space for other potential patients. Even in-hospital deaths have negative connotations for stakeholders or hospital staff as they may involve reimbursements.
Similarly, hospitals can experience penalizations for readmissions or mortalities within 30-day periods (Cassel et al., 2015). These often occur in relation to terminal illness or very severe conditions, and poor quality service can result in such penalization. Palliative care prevents the occurrence of such incidents by providing necessary services without the need for admission to hospital facilities. Community-based palliative care provides a variety of improvements to health outcomes as well as cost-saving and reduction in hospital visits.
Palliative care has financial advantages for patients, as hospital records indicate that palliative care revenue is modest and makes services affordable for most patients. Though this does not inherently contribute to the profitability of a hospital, improved palliative care provides less expenditure and thereby increases the economic stability of a facility. Staff payments are the most profitable factors in palliative care and with future plans to expand the practice among different patients in various stages of illness, an expansion of employment would likely occur. As a result, there would be a positive increase in revenue as a result of staffing changes.
Conclusion
From the article below, the principles of palliative care have been outlined to be focused on patient needs, flexible to change, and evidence-based in terms of treatment. Similarly, the current presence of palliative care in neurology indicates that the specialization of physicians and integration are vital to observing positive health outcomes. Palliative care is also financially viable for hospital facilities as it provides cost-saving mechanisms by creating high-quality care outside the hospital setting.
References
Boersma, I., Miyasaki, J., Kutner, J., & Kluger, B. (2014). Palliative care and neurology: Time for a paradigm shift. American Academy of Neurology, 83(1), 561-567.
Cassel, J. B., Kerr, K. M., Kalman, N. S., & Smith, T. J. (2015). The business case for palliative care: Translating research into program development in the U.S. Journal of Pain and Symptom Management, 50(6), 741-749.
Strand, J. J., Kamdar, M. M., & Carey, E. C. (2013). Top 10 things palliative care clinicians wished everyone knew about palliative care. Concise Review for Clinicians, 88(8), 859-865.