In the past few decades, Palliative Care (PC) has emerged as an important movement that addressed the needs of the sick in terms of relieving suffering and enhancing the quality of life. The World Health Organization defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering” (Lugton & McIntyre, 2005, p.2). These services are of great importance today where illnesses and deaths are associated with chronic, degenerative illnesses such as cancer and dementia.
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In the USA, the concern about improving care at the end of life was required to counter the futile treatments that were offered in the face of suffering and inevitable death (Clark, 2002). Palliative care ensures that terminally ill patient has a “good death” by addressing their physical, emotional, and spiritual needs. It has gained worldwide significance in the past few decades due to the realization that good clinical care can prevent or alleviate suffering for many patients at the end of life. This paper will focus on the current trends and issues in palliative care today. Advances that have been made in this field as well as significant setbacks will be discussed to highlight the development of PC over the last decades.
Current Research in Palliative Care
A key aspect that has been looked at in PC is how to manage the cost of these services. Typically, PC is costly and most of its expenses are incurred from services at the intensive care unit. There is a concern about the quality and cost of care for patients with life-limiting diseases since the financial cost is a major consideration by the patient and his family. Studies suggest that palliative care consultation can help in the reduction of the costs of patient care. Penrod et al (2010) state that consultation can help not only in the improvement of patient’s symptoms but also in increasing the family’s satisfaction. Consultation helps both the patient and the family establish better goals of care and treatment.
From this, they can lower the intensity of treatment and make better decisions regarding the care of the patient. For this reason, many hospitals are investing in palliative care consultation teams to improve the quality of care for patients and reduce its cost (Penrod et al., 2010). Consultation has a positive economic impact since it is associated with a substantial reduction in hospital costs for patients undergoing end-of-life care.
Adequate control of pain is an important issue in palliative care. Since most of the patients under this care experience major pains, it is important for the patient’s quality of life that this pain be controlled effectively. While pain is a prevalent symptom in many PC patients, there is no universally accepted pain assessment tool and this makes it hard for PC professionals to properly manage pain in the patients.
Beckwith and Franklin (2011) assert that it is imperative to assess each pain that a patient has since there may be more than one type. To come up with effective pain management regimes, the PC professional needs to discuss with the patient their pain-related problems. Beckwith and Franklin (2011) suggest that unconventional treatments can be used to assist patients to better cope with their pain. Massages, for example, assist to reduce the pain and fatigue that is commonplace in palliative patients. Techniques such as distraction therapy, relaxation techniques, and complementary therapies also aid in the reduction of pain in chronically ill patients.
Palliative care has most dominantly been availed to cancer patients. However, there have been steps taken to broaden the boundaries of palliative care and offer its benefits to patients suffering from diseases other than cancer (Clark, 2002). Kelly (2011) states that, in recent years, there has been a focus on end-of-life care for patients with chronic respiratory diseases. This is because respiratory diseases are both progressive and degenerative and the complex care needs of the patient as they near their end of life make PC very appropriate. PC services have expanded in the country and a lot of people today benefit from specialist PC.
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Palliative care requires a multidisciplinary approach to provide the best care for the patient. Currently, PC makes use of the Allied Health team which is a multidisciplinary team made up of professionals from several fields. These professionals include doctors, nurses, physiotherapists, social workers, dieticians, and occupational therapists (Lugton & McIntyre, 2005). The individual professionals have competencies in specific fields which are of importance to the provision of quality PC for the patient. Doctors may be ill-suited to provide the psychological interventions that palliative patients need.
However, access to allied is not always possible, and to overcome the lack of specialist services, the existing PC staff can take on some of the roles. For example, social workers can provide psychological services due to the existing therapeutic relationship.
There have been several initiatives established to attempt to improve end-of-life care and specifically the quality of life for terminally ill patients. Heyland (2006) notes that most initiatives have failed to achieve this end since their
attempts to improve end-of-life care have been negatively impacted by a lack of knowledge in what “quality care” means to the patients and their families. The issues that are deemed important to the quality end of life care cannot always be generalized to all seriously ill patients who may have an uncertain prognosis. Research indicates that improvements in end-of-life care are most effective when they focus on the issues that the individual patients and their families deem to be significant (Heyland, 2006). Initiatives to improve satisfaction should therefore include the perspectives of the patients and their families. PC professionals are well suited to obtain both the family’s and patient’s perspectives.
Palliative care has grown to focus not only on the patients but also their families since they are affected significantly as the patient’s disease progresses and the quality of his or her life is impaired. The patient’s family suffers some of the losses that the patient is subjected to such as loss of personal freedom and low expectations for the future (Lugton, 2005). The final stages of a patient’s life are characterized by deterioration of health and a sense of loss of control by both the patient and his or her family. Research indicates that the knowledge and relationship of the PC nurse with the patient and the family are important since it results in an establishment of trust.
Once the nurse is trusted, they are in a better position to assist the patient and family to “acquire strategies of anticipated grief and consolidates the feeling of self-control” (Schmidt, Garcia & Juarez, 2009, p.194). Research has also progressed in the area of communicating bad news with the family since this task is important as it minimizes psychological distress. A common misconception among health care professionals is that the revelation of bad news will lead to heightened anxiety in the patient and his/her family. Research by Schmidt et al. (2009) dismisses this perception and demonstrates that a family’s ignorance of diagnosis results in a higher prevalence of disorders like depression and anxiety.
Palliative patients are predisposed to experience more anxiety disorders, depression, and elevated psychological distress than the general population. An important consideration is that psychological problems in most patients are often left unrecognized and therefore untreated. Penrod (2010) declares that psychological interventions are therefore mandatory in palliative care. Palliative care has traditionally focused on improving the quality of life through alleviating physical symptoms. Lack of access to specialist psychological services has negatively impacted the quality of PC afforded to patients and their families.
Challenges in Palliative Care
Despite its significance in the medical field, there is a lack of awareness and this proves to be a major barrier to the development of palliative care in many developed nations. Lynch et al. (2010) document that lack of awareness and recognition about issues of palliative care is to blame for this condition. As it is, most politicians and policymakers think of palliative care as being about “loving tender care” as opposed to highly qualified professional care.
As a result of this outlook on palliative care, there are limited education and training opportunities in many developing nations. This situation has led to shortages of skilled palliative care workforce in many countries and this has affected the delivery of palliative care. It is also difficult to recruit doctors, nurses, and allied healthcare professionals into palliative care due to a lack of formal training opportunities and recognition for palliative care as a highly qualified professional unit.
There is a significant problem in the prescription of pain medication by PC professionals. Lynch et al. (2010) confirm that there is limited availability of knowledge about opioid analgesics as well as a lack of choices on opioids to use for pain management. The shortage is blamed on the pharmaceutical companies which have little interest in coming up with different kinds of opioids and distributing them since it is not a non-profitable engagement. In addition to this, morphine which is a major pain reliever is not preferred by most patients due to the negative connotation attached to the drug.
This paper set out to discuss the trends and issues in palliative care. It began by articulating the importance of palliative care in today’s health care system. From this research, it is clear that palliative care continues to seek ways to improve end-of-life care for the patient and provide support for the family. Developments that have been made in making PC more cost-effective have been highlighted and the innovations in pain management noted. The paper has articulated the importance placed in providing adequate family support services. The importance of palliative care is increasing as more people require these services and with this advancement, there is a considerable implication for clinical practice.
Beckwith, S. & Franklin, P. (2011). Oxford Handbook of Prescribing for Nurses and Allied Health Professionals. Oxford: Oxford University Press.
Clark, D. (2002). Between hope and acceptance: The medicalisation of dying. British Medical Journal, 324(1), 905-907.
Heyland, D.K. (2006). What matters most in end-of-life care: perceptions of seriously ill patients and their family members? Canadian Medical Association Journal, 174 (5), 627-633.
Kelly, C. (2011). Palliative care for patients with chronic respiratory disease. Nursing Standard. 26(5), 41-46.
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Lugton, J. & McIntyre, R. (2005). Palliative Care: The Nursing Role. NY: Elsevier Health Sciences.
Lynch, T. et al. (2010). Barriers to the development of palliative care in Western Europe. Palliative Medicine, 24(8), 812-819.
Penrod, J.D. et al. (2010). Hospital-Based Palliative Care Consultation: Effects on Hospital Cost. Journal of Palliative Medicine, 13(8), 973-979.
Schmidt, J R., Garcia, P.M., Juarez, M.R. (2009). Bad News for the Patient and family? The worst part of being a health care professional. Journal of Palliative Care, 25 (3), 191- 196.