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Palliative hospice and end of life care

Published : Thursday, 7 January, 2021 at 12:00 AM  Count : 592
ZUBAIR KHALED HUQ
As life expectancy in Bangladesh is increasing steadily with better healthcare and with the growing awareness of the importance of prevention, more and more people will need geriatric care in the future. We have examples in developed countries and we can learn from them, but we have to modify and adapt the programmes according to our socio-cultural norms and religious practices. Their models of family and individual dynamics are different from ours. In Bangladesh, the Constitution makes it an obligation for the state to provide basic health care to the citizens. However, the focus remains on providing clinical or curative treatment without giving much attention to other sectors of the health care industry e.g. preventive, rehabilitative and palliative care.     

"Palliative" derives from the Latin word palliate meaning "cloaked". Palliative care is the term for specialized medical treatment attempting to shield from pain those suffering from life-limiting diseases such as cancer, HIV and Alzheimer's. The World Health Organization describes it as an "approach" that improves the quality of life of such patients and their families through the prevention and relief of suffering. "It involves appropriate physical, psychological, social and spiritual care at the right time.

But with growing life expectancy, experts say, a time will come when it will no longer be possible to ignore such patients and their needs.  The report mentions that there are more people over the age of 65 in the world today than those under the age of five. It quotes Stephen Connor, the senior fellow at the Worldwide Hospice Palliative Care Alliance, as saying: "That's never happened in human history before and it's going to continue to get more pronounced."    

The ever-increasing number of terminally advanced patients admitted to hospitals need palliative care treatment instead of hospital treatment. It is not only cost-effective and but less painful too for patients and their families. The palliative and hospice care is a concept that provides coordinated medical, nursing and allied services to terminally ill patients in an environment of their choice. The palliative care provides physical, psychological, emotional and spiritual support for patients and their families. Palliative care is for all terminally advanced patients suffering from different lethal diseases and organ failures.    

While dying is a normal part of life, death is often treated as an illness. As a consequence, many people die in hospitals, alone and in pain. Palliative care focuses primarily on anticipating, preventing, diagnosing, and treating symptoms experienced by patients with a serious or life-threatening illness and helping patients and their families make medically important decisions. The ultimate goal of palliative care is to improve quality of life for both the patient and the family, regardless of diagnosis. Although palliative care, unlike hospice care, does not depend on prognosis, as the end of life approaches, the role of palliative care intensifies and focuses on aggressive symptom management and psychosocial support.     

Helping patients and their families understand the nature of illness and prognosis is a crucial aspect of palliative care near the end of life. Additionally, palliative care specialists help patients and their families to determine appropriate medical care and to align the patient's care goals with those of the healthcare team. Finally, establishing the need for a medical proxy, advance directives, and resuscitation status is an integral part of palliative care at the end of life.   

The goal of palliative care is to relieve the suffering of patients and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms experienced by patients. As death approaches, a patient's symptoms may require more aggressive palliation. After the patient's death, palliative care focuses primarily on bereavement and support of the family.   

Patients near the end of life may experience extreme symptoms that include physical, spiritual, and psychosocial suffering. Preventing and managing these symptoms while optimizing the quality of life throughout the dying process is the goal of palliative medicine. Factors important to seriously ill patients include adequately controlling pain and other symptoms, avoiding prolongation of the dying process, achieving a sense of self-control, finding meaning in life, and relieving the care burdens of family and loved ones while strengthening and completing those same relationships. As death becomes nearer, the symptom burden increases while the patient and family tolerance of physical and emotional stress decrease. At this time, primary palliative care interventions should take precedence, and the focus on restorative care should decrease.    
 The role of palliative care at the end of life is to relieve the suffering of patients and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms patients 'experience. As death approaches, the symptom burden of a patient may worsen and require more aggressive palliation. As comfort measures intensify, so does the support provided to a dying patient's family. Once death has occurred, the role of palliative care focuses primarily on the support of the patient's family and bereavement.    

Hospice programs far outnumber palliative care programs. Generally, once enrolled through a referral from the primary care physician, a patient's hospice care program, which is overseen by a team of hospice professionals, is administered in the home. Hospice often relies upon the family caregiver, as well as a visiting hospice nurse. While hospice can provide round-the-clock care in a nursing home, a specially equipped hospice facility, or, on occasion, in a hospital, this is not the norm.   

Palliative care teams are made up of doctors, nurses, and other professional medical caregivers, often at the facility where a patient will first receive treatment. These individuals will administer or oversee most of the ongoing comfort-care patients receive. While palliative care can be administered in the home, it is most common to receive palliative care in an institution such as a hospital, extended care facility, or nursing home that is associated with a palliative care team.  

Palliative care aims to treat or manage pain and other physical symptoms. It will also help with any psychological, social or spiritual needs. Treatment will involve medicines, therapies, and any other support that specialist teams believe will help their patients. It includes caring for people who are nearing the end of life. This is called the end of life care. The goal is to help you and everyone affected by your diagnosis to achieve the best quality of life. You might receive palliative care alongside particular treatments, therapies and medicines, such as chemotherapy or radiotherapy.     

End of life care is an important part of palliative care for people who are nearing the end of life. End of life care is for people who are considered to be in the last year of life, but this timeframe can be difficult to predict. End of life care aims to help people live as well as possible and to die with dignity. It also refers to treatment during this time and can include additional support, such as help with legal matters. End of life care continues for as long as you need it.
Dr Zubair Khaled Huq, Family Medicine, Gerontology, Public Health Specialist





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