CASE STUDY: A 51-year-old woman with history of right breast cancer with chest wall extension and lung metastasis.
She was admitted following severe chest pain radiating to the right upper arm.
Lives alone, divorced with three children age 16, 13 and 5 years.
She has a history of drug addiction, she’s withdrawn and angry with everyone persistently asking why me?
These are the various issues in this case:
- Physical Issues: Pain, Breast wall infiltration, Lymphedema.
- Social Issues: Isolation, Personal care issues, financial issues, Child care issues.
- Psychological Issues: Withdrawn, Depression, Anger, Loneliness, Helplessness.
- Emotional Issues: Divorced, Unloved, Fear for children, Unable to express love so that they do not get too close and get hurt.
- Spiritual issue: Why me?
How does a Palliative Team deal with this patient with complex needs?
The World Health Organization recently described palliative care as ” a unique approach that defensively improves the essential quality of personal life of patients and their families experiencing the dilemma associated with a critical illness, through the prevention and relief of suffering utilizing early identification, impeccable assessment, treatment of pain and other problems, physical, psychosocial and spiritual.”(WHO, 2010).
Palliative care goals go beyond comfort in dying and focuses on relieving pain, and other concerns especially physical and psychological suffering, offering emotional and spiritual guardianship and supporting the family by rehabilitating the individual (Lugton, 2009).
Traditionally an alliance approach is employed to sufficiently address the specific needs of patients and their families, including bereavement counseling, necessary if indicated and also enhancing the essential quality of a peaceful life, and positively influencing the possible course of confirmed illness.
Palliative care is usually provided by a squad of healthcare professional with a range of skills and the line-up consists of doctors, nurses, social worker, psychologist, physiotherapist, pharmacist, dietitian and the patient is an essential member of the team as is their family.
The key role of this team efficiently is to typically make active life better for the selected patient, their family and the healthcare team.
Each member needs to voluntarily contribute to the decision making, as well as effective teamwork based on three beneficial effects; good communication, outstanding leadership and necessary coordination (Lugton, 2009).
Explicitly, the role of the multidisciplinary team is critical to the provision of holistic supervision for patients and their relations distinctly showing kindness and compassion and patience.
Patients with a life-threatening illness often develop physical burdens due to pain and some other substantial signs such as fatigue, anorexia, nausea and dyspnea. Worry and profound depression, anxiety, fears are typical after the established diagnosis and any of these symptoms may subtly alter a remarkable person’s unique ability to fulfill roles critical to personal identity.
Palliative care physicians routinely carry out a thorough assessment and recognition of how the symptoms affect their individual’s quality of life.
The patient with debilitating illness commonly confronts stark medical choices. The infirm who realize keenly their unfavorable prognosis constantly wants to know how long they have to live. For patients, it graciously allows prime time to carefully prepare for approaching death, making financial plans or saying goodbye.
For clinicians, awareness and consideration of the diagnosis may be important for informing decision making surrounding medical interventions, achieving a preferred place of death and advance care planning.
Many patients harbor unrealistic ideas about their prognosis and the likely benefits of medical treatments. Open discussion about the prognosis can facilitate patient-centered guidance and shared decision making.
Estimating prognosis is challenging and the most crucial aspect of palliative care is anticipating needs in the sick before they are in medical crisis.
Provides relief from pain and other distressing symptoms
Affirms life and regards dying as a normal process
Intends neither to hasten nor postpone death
Integrates the psychological and spiritual aspects of patient care
Offers a support system to help patients live as actively as possible until death
Several factors may account for the underutilization of palliative care, including confusion about terminology, misperception about its intent and scope, concerns about cost and insurance coverage, and potential mistrust because of perceived economic motives. A lack of physician comfort with end-of-life conversations, including the fear of depriving patients of hope, can also create a barrier to referrals.
In conclusion, the role of the palliative care team includes mitigating suffering, optimizing the quality of life and it cannot be overemphasized in the management of debilitating patients as this reduces the physical and psychological burden on both the patient and their families.
- Center to Advance Palliative Care. About palliative care.
https://www.capc.org/about/palliative-care/ Accessed December 22, 2016.
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American Academy of Hospice and Palliative Medicine Workforce Task Force. Estimate of current hospice and palliative medicine physician workforce shortage.
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