Palliative care (from Latin Latin or sometimes Roman is an Italic language originally spoken in Latium and Ancient Rome. Although often considered a dead language, in view of the fact that it has no native speakers, a small number of scholars can fluently speak it and it continues to be taught in schools and universities and has been, and currently is, used in the process of palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal disfunctions, such as autoimmune diseases. Ecologically, disease is defined as symptoms A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality. A symptom is subjective, observed by the patient, and not measured, rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure A cure or remission is the end of a medical condition. The term may refer specifically to a substance or procedure that ends the medical condition, such as a medication, a surgical operation, a change in lifestyle, or even a philosophical mindset that helps a person suffer. It may also refer to the state of being healed, or cured. The goal is to prevent and relieve suffering Suffering, or pain in a broad sense, is an individual's basic affective experience of unpleasantness and aversion associated with harm or threat of harm. Suffering may be qualified as physical or mental. It may come in all degrees of intensity, from mild to intolerable. Factors of duration and frequency of occurrence usually compound that of and to improve quality of life The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and political science. Quality of life should not be confused with the concept of standard of living, which is based primarily on income for people facing serious, complex illness. Non-hospice palliative care is not dependent on prognosis Prognosis is a medical term to describe the likely outcome of an illness. When applied to large populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because previous research found that this proportion of and is offered in conjunction with curative Curative care or curative medicine is the kind of health care traditionally oriented towards seeking a cure for an existent disease or medical condition. Curative care differs from preventive care and from palliative care (which concentrates on reducing the severity of disease symptoms) and all other appropriate forms of medical treatment.
In the United States ^ b. English is the de facto language of American government and the sole language spoken at home by 80% of Americans age five and older. Spanish is the second most commonly spoken language, a distinction is made between general palliative care and hospice care, which delivers palliative care to those at the end of life In medicine, end-of-life care refers to medical care not only of patients in the final hours or days of their lives, but more broadly, medical care of all those with a terminal illness or terminal condition that has become advanced, progressive and incurable; the two aspects of care share a similar philosophy but differ in their payment systems and location of services. Elsewhere, for example in the United Kingdom The United Kingdom of Great Britain and Northern Ireland[note 7] is a sovereign state located off the northwestern coast of continental Europe. It is an island country, spanning an archipelago including Great Britain, the northeastern part of the island of Ireland, and many small islands. Northern Ireland is the only part of the UK with a land, this distinction is not operative: in addition to specialized hospices, non-hospice-based palliative care teams provide care to those with life-limiting illness at any stage of disease.
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Concept
A recent World Health Organization The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the statement[1] describes palliative care as "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." More generally, however, the term "palliative care" may refer to any care that alleviates symptoms, whether or not there is hope of a cure by other means; thus, palliative treatments may be used to alleviate the side effects In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery. An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect, and may result from an unsuitable or incorrect dosage or procedure, which could be due to medical of curative treatments, such as relieving the nausea Nausea , is a sensation of unease and discomfort in the upper stomach with an urge to vomit. An attack of nausea is known as a qualm associated with chemotherapy Chemotherapy, in its most general sense, is the treatment of a disease by chemicals especially by killing micro-organisms or cancerous cells. In popular usage, it refers to antineoplastic drugs used to treat cancer or the combination of these drugs into a cytotoxic standardized treatment regimen. In its non-oncological use, the term may also refer.
The term "palliative care" is increasingly used with regard to diseases other than cancer Cancer /ˈkænsər/ (medical term: malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties such as chronic, progressive pulmonary disorders, renal disease Causes of nephropathy include administration of analgesics, xanthine oxidase deficiency, and long-term exposure to lead or its salts. Chronic conditions that can produce nephropathy include systemic lupus erythematosus, diabetes mellitus and high blood pressure , which lead to diabetic nephropathy and hypertensive nephropathy, respectively, chronic heart failure, HIV/AIDS, and progressive neurological conditions Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. The corresponding surgical specialty. In addition, the rapidly growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness.
Although the concept of palliative care is not new, most physicians have traditionally concentrated on trying to cure patients. Treatments for the alleviation of symptoms were viewed as hazardous and seen as inviting addiction and other unwanted side effects.[2]
The focus on a patient's quality of life has increased greatly during the past twenty years. In the United States today, 55% of hospitals with more than 100 beds offer a palliative-care program,[3] and nearly one-fifth of community hospitals have palliative-care programs.[4] A relatively recent development is the concept of a dedicated health care team that is entirely geared toward palliative treatment: a palliative-care team.
Comparison to hospice
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There is often confusion between the terms hospice Hospice is a type of care and a philosophy of care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice has been evolving since the 11th century. Then, and for centuries thereafter, hospices were places of hospitality for the sick, and palliative care.
In the United States, hospice services and palliative care programs share similar goals of providing symptom relief and pain management Pain management is that branch of medicine employing an interdisciplinary approach to easing the suffering and improving the quality of life of those living with pain. The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners. Pain sometimes resolves.[5] Non-hospice palliative care is appropriate for anyone with a serious, complex illness, whether they are expected to recover fully, to live with chronic illness for an extended time, or to experience disease progression. In contrast, although hospice care is also palliative, the term hospice applies to care administered towards the end of life.
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 the psychological and spiritual aspects of patient care;
- offers a support system to help patients live as actively as possible;
- offers a support system to help the family cope;
- uses a team approach to address the needs of patients and their families;
- will enhance quality of life;
- is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy.
Goals
While palliative care may seem to offer an incredibly broad range of services, the goals of palliative treatment are extremely concrete: relief from suffering, treatment of pain and other distressing symptoms, psychological and spiritual care, a support system to help the individual live as actively as possible, and a support system to sustain and rehabilitate the individual's family.[6]
History
Palliative care began in the hospice movement and is now widely used outside of traditional hospice care. Hospices were originally places of rest for travelers in the 4th century. In the 19th century a religious order established hospices for the dying in Ireland Ireland (pronounced [ˈaɾlənd],; Irish: Éire, pronounced [ˈeːɾʲə] ( listen); Ulster Scots: Airlann) is the third-largest island in Europe and the twentieth-largest island in the world. It lies to the northwest of continental Europe and is surrounded by hundreds of islands and islets. To the east of Ireland is Great Britain, separated from and London London is a leading global city, the world's largest financial centre alongside New York, and has the largest city GDP in Europe. Central London is home to the headquarters of most of the UK's top 100 listed companies and more than 100 of Europe's 500 largest. London's influence and strengths in the arts, education, entertainment, fashion, finance,. The modern hospice is a relatively recent concept that originated and gained momentum in the United Kingdom The United Kingdom of Great Britain and Northern Ireland[note 7] is a sovereign state located off the northwestern coast of continental Europe. It is an island country, spanning an archipelago including Great Britain, the northeastern part of the island of Ireland, and many small islands. Northern Ireland is the only part of the UK with a land after the founding of St. Christopher's Hospice in 1967. It was founded by Dame Cicely Saunders Dame Cicely Mary Saunders, OM, DBE was a prominent Anglican nurse, physician and writer, involved with many international universities. She helped the dying and terminally ill end their lives in the most comfortable ways possible, widely regarded as the founder of the modern hospice movement.
The hospice movement has grown dramatically in recent years. In the UK in 2005 there were just under 1700 hospice services consisting of 220 inpatient units for adults with 3156 beds, 33 inpatient units for children with 255 beds, 358 home care services, 104 hospice at home services, 263 day care services, and 293 hospital teams. These services together helped over 250,000 patients in 2003 & 2004. Funding varies from 100% funding by the National Health Service to almost 100% funding by charities, but the service is always free to patients.
Hospice in the United States has grown from a volunteer-led movement to improve care for people dying alone, isolated, or in hospitals, to a significant part of the health care system. In 2005 more than 1.2 million individuals and their families received hospice care. Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, twenty-four hour/seven day a week access to care and support for loved ones following a death. Most hospice care is delivered at home. Hospice care is also available to people in home-like hospice residences, nursing homes, assisted living facilities, veterans' facilities, hospitals, and prisons.
The first United States hospital-based palliative care programs began in the late 1980s at a handful of institutions such as the Cleveland Clinic and Medical College of Wisconsin. Since then there has been a dramatic increase in hospital-based palliative care programs, now numbering more than 1400. 80% of US Hospitals with more than 300 beds have a program.[3]
A 2010 study regarding the availability of palliative care in 120 US cancer center hospitals reported the following: Only 23% of the centers have beds that are dedicated to palliative care; 37% offer inpatient hospice; 75% have a median time of referral to palliative care to the time of death of 30 to 120 days; Research programs, palliative care fellowships, and mandatory rotations for oncology fellows were uncommon.[7]
The results of a 2010 study in The New England Journal of Medicine showed that lung cancer patients receiving early palliative care experienced less depression, increased quality of life and survived 2.7 months longer than those receiving standard oncologic care.[8]
Hospital palliative care programs today care for non-terminal patients as well as hospice patients. The Patient Protection and Affordable Care Act The Patient Protection and Affordable Care Act is a bill passed by the United States Senate at 7:05am on December 24, 2009 currently being debated by house and senate would seek to expand palliative care in the U.S.
The first pan-European centre devoted to improving patient palliative care and end of life care was established in Trondheim, Norway in 2009. The centre is based at NTNU’s Faculty of Medicine and at St. Olavs Hospital/Trondheim University Hospital, and coordinate efforts between groups and individual researchers across Europe, specifically Scotland, England, Italy, Denmark, Germany and Switzerland, along with the USA, Canada and Australia.
Practice
See also: Hospice care in the United StatesIn the United States hospice and palliative care represent two different aspects of care with similar philosophy, but with different payment systems and location of services. Palliative care services are most often provided in acute care hospitals organized around an interdisciplinary consultation service with or without an acute inpatient palliative care ward. Palliative care may also be provided in the dying person's home as a "bridge" program between traditional US home care services and hospice care or provided in long-term care facilities. In contrast over 80% of hospice care in the US is provided in a patient's home with the remainder provided to patients residing in long-term care facilities or in free standing hospice residential facilities. In the UK hospice is seen as one part of the specialty of palliative care and no differentiation is made between 'hospice' and 'palliative care'.
In most countries hospice and palliative care is provided by an interdisciplinary team consisting of physicians A physician—also known as doctor of medicine, medical doctor, or simply doctor—practices the ancient profession of medicine, which is concerned with maintaining or restoring human health through the study, diagnosis, and treatment of disease or injury. This properly requires both a detailed knowledge of the academic disciplines underlying, registered nurses A Registered Nurse is a health care professional responsible for implementing the practice of nursing through the use of the nursing process in conjunction with other health care professionals. Registered nurses work as patient advocates for the care and recovery of the sick and maintenance of their health. In their work as advocates for the, nursing assistants, social workers Social work is a professional and academic discipline committed to the pursuit of social welfare and social change. The field works towards research and practice to improve the quality of life and to the development of the potential of each individual, group and community of a society. Social workers perform interventions through research, policy,, hospice chaplains, physiotherapists, occupational therapists, complementary therapists, volunteers, and, most important, the family In human context, a family is a group of people affiliated by consanguinity, affinity, or co-residence. In most societies it is the principal institution for the socialization of children. The team's focus is to optimize the patient's comfort. Additional members of the team are likely to include certified nursing assistants or home health care aides, volunteers from the community (largely untrained but some being skilled medical personnel), and housekeepers.
In the UK palliative care services offer inpatient care, home care, day care, and outpatient services, and work in close partnership with mainstream services. Hospices often house a full range of services and professionals for both pediatric and adult patients.
In the US palliative care services can be offered to any patient without restriction to disease or prognosis. Hospice care under the Medicare Hospice Benefit, however, requires that two physicians certify that a patient has less than six months to live if the disease follows its usual course. This does not mean, though, that if a patient is still living after six months in hospice he or she will be discharged from the service. Such restrictions do not exist in other countries such as the UK.
Caregivers, both family and volunteers, are crucial to the palliative care system. Caregivers and patients often form lasting friendships over the course of care. As a consequence caregivers may find themselves under severe emotional and physical strain. Opportunities for caregiver respite Respite programs provide planned short-term and time-limited breaks for families and other unpaid care givers of children with a developmental delay and adults with an intellectual disability in order to support and maintain the primary care giving relationship. Respite also provides a positive experience for the person receiving care. The term & are some of the services hospices provide to promote caregiver well-being. Respite may last a few hours up to several days (the latter being done usually by placing the patient in a nursing home A nursing home, convalescent home, Skilled Nursing Unit , care home or rest home provides a type of care of residents: it is a place of residence for people who require constant nursing care and have significant deficiencies with activities of daily living. Residents include the elderly and younger adults with physical or mental disabilities or in-patient hospice unit for several days).
Because palliative care sees an increasingly wide range of conditions in patients at varying stages of their illness it follows that palliative care teams offer a range of care. This may range from managing the physical symptoms in patients receiving treatment for cancer, to treating depression in patients with advanced disease, to the care of patients in their last days and hours. Much of the work involves helping patients with complex or severe physical, psychological, social, and spiritual problems. In the UK over half of patients are improved sufficiently to return home. Most hospice organizations offer bereavement counseling Grief counseling is a form of psychotherapy that aims to help people cope with grief and mourning following the death of loved ones, or with major life changes that trigger feelings of grief to the patient's partner or family should he die.
In the US board certification for physicians in palliative care was through the American Board of Hospice and Palliative Medicine; recently this was changed to be done through any of 11 different specialty boards through an ABMS-approved procedure. More than 50 fellowship programs provide 1–2 years of specialty training following a primary residency. In the UK palliative care has been a full specialty of medicine since 1989 and training is governed by the same regulations through the Royal College of Physicians as with any other medical specialty.[9]
Funding for hospice and palliative care services varies. In the UK and many other countries all palliative care is offered free to the patient and their family, either through the National Health Service (as in the UK) or through charities working in partnership with the local health services. Palliative care services in the US are paid by philanthropy, fee-for service mechanisms, or from direct hospital support while hospice care is provided as Medicare benefit; similar hospice benefits are offered by Medicaid and most private health insurers. Under the Medicare Hospice Benefit (MHB) a patient signs off their Medicare Part A (hospital payment) and enrolls in the MHB with direct care provided by a Medicare certified hospice agency. Under terms of the MHB the Hospice agency is responsible for the Plan of Care and may not bill the patient for services. The hospice agency, together with the patient's primary physician, is responsible for determining the Plan of Care. All costs related to the terminal illness are paid from a per diem rate (~US $126/day) that the hospice agency receives from Medicare - this includes all drugs and equipment, nursing, social service, chaplain visits, and other services deemed appropriate by the hospice agency; Medicare does not pay for custodial care. Patients may elect to withdraw from the MHB and return to Medicare Part A and later re-enroll in hospice.
The first pan-European centre devoted to improving patient palliative care and end of life care was established in Trondheim, Norway in 2009. The centre is based at NTNU’s Faculty of Medicine and at St. Olavs Hospital/Trondheim University Hospital, and coordinate researchers across Europe, specifically Scotland, England, Italy, Denmark, Germany and Switzerland, along with the USA, Canada and Australia.
Fri, 03 Sep 2010 12:38:42 GMT+00:00
The Christian Institute However, the truth is that Scotland offers excellent care for people suffering from extraordinary pain. Our palliative care services are capable of more ...
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ue, 18 Aug 2009 21:43:40 GM
Palliative care. may boost mood and quality of life for people with advanced cancer, but it may not help them live longer, a new study shows.
