THE PHILOSOPHY OF PALLIATIVE
CARE...
- Affirms life and regards
death as a normal process
- Neither hastens nor
postpones death
- Relieves pain and other
distressing symptoms
- Integrates psychological/spiritual
aspects of care
- Offers a support system
to help the patient live
- Offers a support system
to help the family cope
©Ian Anderson Continuing Education
Program in End-of-Life Care
Patients and families face
multiple issues during illness and bereavement
that cause suffering. These issues can be grouped
into 8 domains.
Primary diagnosis,
prognosis, evidence
Secondary diagnoses, eg, dementia, psychiatric diagnoses, substance
use,
trauma
Co-morbidities, eg, delirium, seizures, organ failure
Adverse events, eg, side
effects, toxicity
Allergies |
Pain and other
symptoms *
Level of consciousness, cognition
Function, safety, aids:
• Motor,
eg,
mobility, swallowing, excretion
• Senses,
eg,
hearing, sight, smell, taste,
touch
• Physiologic,
eg,
breathing, circulation Sexual
Fluids, nutrition
Wounds
Habits, eg, alcohol, smoking
|
Personality,
strengths, behavior, motivation
Depression, anxiety
Emotions, eg, anger, distress, hopelessness, loneliness
Fears, eg, abandonment, burden, death
Control, dignity, independence
Conflict, guilt, stress, coping
responses
Self-image, self-esteem |
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Loss
Grief, eg, acute, chronic,
anticipatory
Bereavement planning
Mourning |
Activities of
daily living,
i.e., for personal care =
ambulation, bathing, toileting, feeding, dressing
and transfers;
for household activities = cooking, cleaning, laundry, banking,
shopping
Caregiving
Dependents, pets
Telephone access, transportation |
Meaning, value
Existential, transcendental
Values, beliefs, practices, affiliations
Spiritual advisors, rites, rituals
Symbols, icons |
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Cultural values,
beliefs, practices
Relationships, roles with family, friends, community
Isolation, abandonment, reconciliation
Safe, comforting environment
Privacy, intimacy
Routines, rituals, recreation, vocation
Financial resources, expenses
Legal, eg, powers of attorney for business, for healthcare, advance
directives, last will/ testament, beneficiaries
Family caregiver protection
Guardianship, custody issues |
Life closure,
eg,
completing business,
closing relationships,
saying goodbye
Gift giving, eg, things, money, organs, thoughts
Legacy creation
Preparation for expected death
Anticipation and management of
physiological changes in the last hours of life
Rites, rituals
Pronouncement, certification
Peri-death care of family,
handling of the body
Funerals, memorial services,
celebrations |
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* Other common symptoms include,
but are not limited to:
Cardio-respiratory: breathlessness, cough, edema, hiccups, apnea, agonal
breathing patterns
Gastrointestinal: nausea, vomiting, constipation, obstipation, bowel obstruction,
diarrhea, bloating, dysphagia, dyspepsia
Oral conditions: dry mouth, mucositis
Skin conditions: dry skin, nodules, pruritus, rashes
General: agitation, anorexia, cachexia, fatigue, weakness, bleeding, drowsiness,
effusions (pleural, peritoneal), fever/chills, incontinence, insomnia,
lymphoedema, myoclonus, odor, prolapse, sweats, syncope, vertigo
Ref: A Model to Guide Hospice Palliative Care, Canadian Hospice
Palliative Care Association, Ottawa
, Canada , 2002
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