NCM 118: MS 3

MIDTERM: PRINCIPLES OF PALLIATIVE CARE

PRINCIPLES OF PALLIATIVE CARE Alternative Approach to Pain

Mind-body therapies
Managing Pain
● Pain may be anything from a dull ache to a sharp stab
and can range from mild to extreme in severity. It may
be located in one part of the body or be widespread.
● Causes of pain in adults include medical conditions (such
as cancer, arthritis and back problems), injuries and
surgery. The most commonly reported pain is back pain.
Pain involving the limbs, shoulder, neck and head is also
Acupuncture
common.

Acute pain
Acute pain is a normal response to tissue injury, which starts
suddenly and is usually short lived.

Chronic (ongoing) pain

Chronic (ongoing) pain persists beyond the normal time of Acupressure
healing and generally lasts for longer than three months. The
vast majority of people with chronic pain have it for more
than a year. This type of pain is usually the result of an injury
(for example, a sports or work accident), illness or other
health problem. The cause is unknown in around one-third of
cases.

Clinical Manifestation of Pain

● Increased heart rate and blood pressure
● Changes to blood gases, namely reduced oxygen and Chiropractic treatment and massage
increased carbon dioxide
● Higher levels of stress hormones including cortisol and
adrenaline
● Gastrointestinal problems such as slowed digestion
● Musculoskeletal problems such as tension and fatigue
● Emotional problems such as anxiety and depression.

Pharmacology
● Medications available for the management of pain
include: Paracetamol
● Aspirin and other non-steroidal anti-inflammatory drugs Therapeutic touch & Reiki
(NSAIDs), such as ibuprofen – these medicines reduce
inflammation (redness and swelling)
● Opioid drugs, such as codeine and morphine – these
medicines treat moderate to severe pain
● Local anaesthetics.

Patient’s control Analgesia:

Herbal & Nutritional Supplement

Dietary approach
NCM 118: MS 3
MIDTERM: PRINCIPLES OF PALLIATIVE CARE
Palliative Care vs Hospice
● Hospice is a Medicare benefit- other insurance plans
also have Hospice benefits; it is a way of paying for a
certain type of care
● Hospice care can be provided in the home setting or in a
facility
● Palliative care encompasses all of hospice care, but also
supports curative or life prolonging therapies; prognosis
> 6mo
Domains of Palliative Care
● Structure and Processes of Care
● Physical Aspects of Care
● Psychological and Psychiatric Aspects of Care
● Social Aspects of Care
● Spiritual, Religious and Existential Aspects of Care
● Cultural Aspects of Care
● Care of the Imminently Dying Patient
● Ethical and Legal Aspects of Care
Physical Aspects of Care
● Pain, other symptoms, and side-effects are managed
based upon the best available evidence
Breathlessness
Anorexia
Insomnia
Fatigue/weakness
Anxiety
Nausea
Depression
Confusion
Constipation
● The outcome of symptom management is the safe and
timely reduction of the symptom to a level that is
acceptable to the patient
Psychological and Psychiatric Aspects of Care
● The interdisciplinary team includes professionals with
training and skills in the psychological consequences and
psychiatric co-morbidities of serious illness
● Appropriate pharmacologic and non-pharmacologic
therapies are initiated for depression, anxiety, insomnia
or other symptoms
● Bereavement support is available for up to 13 months
Social Aspects of Care
● Comprehensive interdisciplinary assessment identifies
the social needs for patients and their families
● Referrals to appropriate services are made that meet
identified social needs:
Access to care
Transportation
Rehabilitation
Medications
Counseling
Community resources
Equipment
Advocacy
Help in the home, school or work
Spiritual, Religious and Existential Aspects of Care
● Professionals with expertise in assessing and responding
to spiritual and existential issues are included on the
interdisciplinary team
● Regular ongoing exploration of spiritual and existential
concerns occurs as appropriate
● Contacts with spiritual/religious communities, groups, or
individuals as desired by the patient and/or family are
facilitated
● Religious or spiritual rituals as desired by the patient
and/or family are supported
Cultural Aspects of Care
● The Palliative Care team assesses and attempts to meet
the culture-specific concerns of patients and their
families
● Communications are respectful of cultural preferences
regarding disclosure, truth-telling and decision-making
● The program attempts to respect and accommodate the
range of language, dietary, and ritual practices of
patients and their families
Care of the patient who is imminently dying
● Signs and symptoms of impending death are recognized
and communicated and appropriate care is provided to
the patient and family based on their preferences
● End-of-life concerns, hopes, fears and expectations are
addressed openly and honestly in the context of social
and cultural customs
Case Analysis
● Ms. Mankin is a 75 year old who is diagnosed with stage
IV colon cancer. While consistently in pain, she refuses
any medications to address the issue. Ms. M is also
unable to eat any solid food but is adamant about being
able to return home, where she lives alone.
● Mr. D is an 84 year old with metastatic prostate cancer
and dementia. He had been living at home with his son
and receiving home hospice services, but due to
increasing need for 24/hr care the hospice agency felt
being at home was no longer a safe environment.
Attempts to assist family with Medicaid applications (for
additional home services) were unsuccessful.