What is palliative care? What is palliative care? Dr Claire L Hookey

Transcription

1 What is palliative care? What is palliative care? Dr Claire L Hookey

2 Palliative Care 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.. WHO

3 Palliative Care provides relief from pain and other distressing symptoms affirms life and regards dying as a normal process intends neither to hasten or postpone death integrates psychological and spiritual aspects of patient care supports patients to live as actively as possible until death helps the family cope during the patient s illness and their own bereavement uses a team approach will enhance quality of life, and may also positively influence the course of illness is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life

4 Who does palliative care? General palliative care Majority of palliative care is provided by nonspecialist palliative care staff - Primary care, hospital doctors and nurses Specialist palliative care Palliative Care multidisciplinary team including specialist nurses and palliative care doctors

5 Integrating Palliative Care into HF management The treatment imperative marginalizes palliative approaches The possibility of dying often remains unacknowledged Apparently benign nature and unpredictability discourages EOL considerations There is a need for increased communication about palliative options Integrated approach: cardiology-primary care-palliative care team is desirable Stuart B, The nature of heart failure as a challenge to the integration of palliative care services,, Curr Opin Support Palliat Care, 2007 Dec;1(4):

6 What is needed now is courage among clinicians to open early dialogue about disease process, prognosis and palliative options with the growing number of patients with advanced disease.

7 Steps in the provision of palliative care for patients with HF optimizing evidence-based therapy sensitively breaking bad news to the patient and family establishing an advanced care plan including patients preferences for treatment options education and counselling on relevant optimal selfmanagement organizing multidisciplinary services identifying end-stage HF re-exploring goals of care optimizing symptom management at the end of life care after death including bereavement support. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology 2009

8 Palliative Care in HF Integrated care approach Appropriate cardiac interventions Optimising cardiac medication Open communication with patients and carers Addressing specific symptoms Advance Care Planning Psychological, social and spiritual support

9 Implications for generalist palliative care providers Implications for specialist palliative care providers

10 Barriers to involving SPC Palliative care services will be overwhelmed 10% patients known to heart failure nurses Patients would not want referral to hospice Some evidence of acceptability to patients Palliative care staff do not have necessary skills Mutual support and education with cardiology

11 Palliative care in HF A PC approach is applicable to HF patients should be integrated as part of a team approach to comprehensive HF care and should not be reserved for those who are expected to die within days or weeks. should be considered. as part of comprehensive care provision over the whole disease trajectory. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology 2009