I had reason today to reflect on palliative care in another context.
The common perception of palliative care is that is about managing death. It is not. The best definition I have heard is that palliative care is about symptom management. As such it is appropriate to engage with palliative care early in the treatment process to manage symptoms.
I have used the example a couple of times and it seems to hold up. In the hospital Yvette was having her pain managed by morphine. It left her confused and sleepy. Several times nurses and doctors made the comment that her liver didn't seem to be metabolizing the morphine so it was accumulating in her system. But nobody did anything about it. When we got to hospice they dropped the morphine, moved to fentanyl and haldol - and I had my wife back.
There was a palliative team including not only a palliative doctor but pharmacist, nurse and social worker that provided excellent information and moved quickly to manage symptoms as they arose. In hindsight this was a group that could have been brought into the process much sooner. Our fear of admitting that it would be managing dying slowed that process down.
Lianne (admin at http://cancerconnection.ca) pointed me to this info from the World Health Organization that I think sums it up quite nicely and should shed some light on this for many people who may think it is only applicable in the very end days.
Palliative care is an approach that improves the quality of life of patients and their families facing the problem 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, psycho-social and spiritual. 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 until death;
- offers a support system to help the family cope during the patients illness and in their own bereavement;
- uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
- will enhance quality of life, and may also positively influence the course of illness;
- 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, and includes those investigations needed to better understand and manage distressing clinical complications.