Palliative Medicine

Palliative care is one of the nascent concepts of healthcare in India. People are yet to discover the spectrum of Palliative care. Some consider it as only End-of-life-care which is not correct. Some are confused on whether it is even required. While some think how opting palliative care will benefit their patient and how it will ease care-givers and other family members life. 

In this comprehensive guide, we will go step by step to understand key aspects of Palliative care including its overview, importance, applicability to various diseases, common symptoms, and frequently asked questions.

So, let’s first understand the meaning of Palliative Care.

Meaning of Palliative Care:

Palliative care is an extra layer of care alongside your ongoing treatment. The main aim of palliative care is to provide comfort to patient by managing pain, distressing symptoms and creating a road map to care in alignment with the primary team, patient and family members to improve overall quality of life. 

What does quality of life refer to?

Improving Quality of life refers to keeping the patient

1: Pain free whether its post-surgery pain, cancer pain or chronic pain.

2: Anxiety free

3: Helping them to have a good sleep

4: No diarrhoea, constipation or bloating

5: Able to spend some good time with children and other family members

6: Management of overall body discomfort

7: Counselling/guidance of patient or family members whenever required

8: Fixing a balanced diet according to persons’ need

9: Assessing where extra care is required. For e.g. – a patient who is disoriented/immobile might need frequent oral or perineal care. 

10: Training of family members on how to take good care of patient after discharge.

11: Maintaining over-all hygiene of the patient

12: Preventing/managing bed-sores. 

Range of Palliative Care Services -

Palliative care doesn’t merely mean treating the disease rather it is a holistic approach. Alongside managing patient, it aims to support family carers as well. Palliative care encompasses a range of services, including pain management, emotional support, and spiritual care. The goal is to provide comprehensive care that goes beyond just treating the disease.

*Distressing symptoms – vomiting, nausea, constipation, breathlessness, ulcers, swelling, cancer related fatigue etc.

Who needs Palliative Care?

Palliative care services can be offered to people of any age viz; adult men & women, children, geriatric population in short anyone who have a serious or life-threatening illness like, 

1: Cancer

2: Disorders of the blood and bone marrow necessitating stem cell transplant

3: Heart disease

4: Cystic fibrosis

5: Dementia

6: End-stage liver disease

7: Kidney failure

8: Lung disease

9: Parkinson's disease

10: Stroke, along with other severe illnesses

Who provides Palliative Care?

Palliative care in a hospital is provided by a dedicated Palliative Medicine/Care Team which may include doctors, nurses, social workers, religious leaders and other specialists working collaboratively to address the diverse needs of the patient and their families.

What are the potential benefits of Palliative Medicine team for patient and family members? 

1. Provides pain and symptom control.
2. Improves quality of life.
3. Puts the patient's desires, goals and decisions first.
4. Supports the patient and family.
5. Helps patients and families understand treatment plans.
6. Improves quality of life.
7. Provides pain and symptom control.
8. Focuses on body, mind and spirit.
9. Reduces unnecessary hospital and ICU visits.
10. Increase in patient family satisfaction with care
11. In some cases, extended survival

What does the Palliative Medicine team will do?

1. Early Intervention: Palliative care is not confined to end-of-life situations. Its early integration, even at the time of diagnosis, ensures that individuals and their families receive the necessary support from the onset of the illness. This can positively impact the entire trajectory of the disease.
2. Management of physical symptoms - A patient undergoes a lot of physical stress due to illness, treatment and medication like; nausea, constipation, pain, restlessness, breathlessness, change in appetite, fatigue, insomnia and what not. So, a palliative care team manages all these symptoms to keep the patient comfortable.
3. Emotional and Psychological Support: Serious illnesses often take a toll not only on the body but also on mental and emotional well-being. Palliative care addresses the emotional aspects of the illness, providing counselling, support, and resources to help individuals and their families cope with the psychological challenges.
4. Enhancing Comfort: Palliative care strives to enhance the comfort and quality of life of individuals, irrespective of the stage of the illness. It provides a support system that acknowledges the unique needs and preferences of each patient, promoting a sense of control and dignity.
5. Integrated Team work- Palliative care team will closely work with other departments viz; physiotherapy, dietetics, psychologist, primary treatment team etc to handle all the challenges to maintain a comfortable environment for the patient.
6. Facilitating Communication: Palliative care encourages open and honest communication between healthcare providers, patients, and their families. This transparent communication fosters informed decision-making and ensures that the individual's values and preferences are respected throughout the course of their illness.
7. Deciding goals of care - it is very important for the patient’s family to decide practical goals of care.  Setting up clear goals help family members to be prepared for the outcome and it reduces panic situation. It also helps to make informed decisions by patients & their family members.
8. Taking care of caregiver`s needs – A caregiver just like patient has to undergo a lot. They have to handle the patient, other family members, paper- work & finances that can take a toll on their mental and physical health. With Palliative medicine team caregivers get a confidential space to discuss their deepest concerns. The team may guide them “how to take care of themselves”, “taking turns to care for the patient”, getting enough sleep, healthy diet, “guilt free me time” etc.
9. Dignified End-of-Life Care: In cases where end-of-life care becomes a focus, palliative care ensures that individuals receive care that aligns with their wishes and values. It emphasizes dignity, respect, and compassionate support during this sensitive period.

Frequently asked questions:

Q1: Where can a patient receive palliative care?

Ans: Palliative care can be given in a hospital, hospice care or at home. Family members can discuss and decide the place of palliative care with the help/guidance of their Palliative Care Physician.

Q2: How can one receive Palliative Care at home?

Ans: One can receive palliative care at home under continues guidance of Palliative Medicine team.  A lot of home health care set-up options are available. Your Palliative Medicine physician will guide you what equipment or medical devices or medical staff are required for palliative care at home.

Q3: How is palliative care different from hospice care? 

Ans: While both aim to enhance quality of life, palliative care can be provided alongside curative treatments and at any stage of an illness. Hospice care is typically reserved for those with a life expectancy of six months or less.

Q4: While receiving Palliative care, will I still be able to see my personal/primary/treating doctor?

 Ans: Yes. Starting palliative care doesn`t always mean stopping your current treatment. 

Q5: Is Palliative care covered by insurance in India?

Ans: Most insurance plans public as well as private cover Palliative care.

Q6: How can a patient receive Palliative care?

Ans: You can request- Patients or their families can request palliative care services at any time during a serious illness.

You will be referred- consulting physicians or medical staff at hospital or other health care facilities will refer a patient or request that hospitalized patients be evaluated for services by the hospital's palliative care team.

Q7: In what ways a patient can receive palliative care services?

Ans:

1. Inpatient services
2. Outpatient basis
3. Home care

Q8: When should palliative care be started? 

Ans: Palliative care can be started at any point after an illness is diagnosed alongside curative treatment. Think of palliative care as an extra layer of support for your entire journey.