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Encyclopedia > Palliative care

Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than providing a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. Non-hospice palliative care is not dependent on prognosis and is offered in conjunction with curative and all other appropriate forms of medical treatment. It should not be confused with hospice care which delivers palliative care to those at the end of life. In the UK this distinction is not operative; hospices and non hospice based palliative care teams both provide care to those with life limiting illness at any stage of their disease. (See "History" and "Practice" below for additional information on hospice and hospice care.) Latin is an ancient Indo-European language originally spoken in Latium, the region immediately surrounding Rome. ... The term disease refers to an abnormal condition of an organism that impairs function. ... The term symptom (from the Greek meaning chance, mishap or casualty, itself derived from συμπιπτω meaning to fall upon or to happen to) has two similar meanings in the context of physical and mental health: Strictly, a symptom is a sensation or change in health function experienced by a patient. ... Cure can be: successful treatment of disease preserve (meat, for example), as by salting, smoking, or aging (see curing) prepare, preserve, or finish (a substance) by a chemical or physical process (one example is the curing, or seasoning, of a cast iron pan; another is the curing of an adhesive... Suffering is any aversive (not necessarily unwanted) experience and the corresponding negative emotion. ...

Contents

Concept

The term "palliative care" may be used generally to refer to any care that alleviates symptoms, even if there is hope of a cure by other means; thus, a recent WHO statement[1] calls palliative care "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness." In some cases, palliative treatments may be used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherapy. Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ... For other uses, see Nausea (disambiguation). ... Chemotherapy is the use of chemical substances to treat disease. ...


The term "palliative care" is increasingly used with regard to diseases other than cancer, such as chronic, progressive pulmonary disorders, renal disease, chronic heart failure or progressive neurological conditions. In addition, the rapidly-growing field of pediatric palliative care has clearly shown the need for services geared specifically for children with serious illness. Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... Congestive heart failure (CHF) (also called congestive cardiac failure and heart failure) is the inability of the heart to pump a sufficient amount of blood throughout the body, or requiring elevated filling pressures in order to pump effectively. ... Neurology is a branch of medicine dealing with disorders of the nervous system. ...


Though the concept of palliative care is not new, most physicians have traditionally concentrated on aggressively trying to cure patients. Available treatments for alleviation of symptoms were viewed as hazardous and seen as inviting addiction and other unwanted side effects.[2].


Over the past twenty years, the focus on a patient's quality of life has gained substantial ground. Today in the United States, 55% of U.S. hospitals with over 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, called a palliative care team.


Clarification

There is often confusion between the terms hospice and palliative care. In North America, hospice has evolved into a type of time-limited end-of-life care that is not specifically focused around palliative services.[5] Non-hospice palliative care, however, 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.[6] In bioethics, end-of-life medical care covers a range of treatment options for patients who considered critically ill. ...


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 the individual's family.[7]


History

Palliative care today is no longer limited to hospice care, however palliative care began in the hospice movement. Hospices were originally places of rest for travelers in the 4th century CE. In the 19th century a religious order established hospices for the dying in Ireland and London. The modern hospice is a relatively recent concept that originated and gained momentum in the United Kingdom after the founding of St. Christopher's Hospice in 1967. It was founded by Dame Cicely Saunders, widely regarded as the founder of the modern hospice movement. This article is about the capital of England and the United Kingdom. ... Dame Cicely Mary Saunders, OM, DBE (June 22, 1918 in Barnet, Hertfordshire, England – July 14, 2005 at St Christophers Hospice, South London, England) was a prominent English nurse, physician and writer, involved with many international universities. ...


Since its beginning, the hospice movement has grown dramatically. In the UK in 2005 there were just under 1700 hospice services. This consisted 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 2003/4. 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 who were dying alone, isolated, in hospitals to a significant part of the healthcare system. In 2005 more than 1.2 million individuals and their family caregivers 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. The majority of hospice care is delivered at home or in a home-like hospice residence. Hospice care is also available to people in 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 only 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 1200. Over 55% of U.S. hospitals over 100 beds have a program. [8] Hospital palliative care programs today care for non-terminal patients as well as hospice patients. Palliative care programs in hospitals can be difficult to financially support given the multiple employees on a palliative care team and the time-intensive involvement with patients without adequate reimbursement. Therefore, strategies for funding palliative care programs typically focus on cost-savings for the hospital as opposed to revenue-generating models.


Practice

In the United States, hospice and palliative care represent two different aspects of care with similar philosophy, but 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, registered nurses, social workers, hospice chaplains, physiotherapists, occupational therapists, complimentary therapists, volunteers and, most importantly, the family. The focus of the team 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 as well), and housekeepers. The Doctor by Luke Fildes This article is about the term physician, one type of doctor; for other uses of the word doctor see Doctor. ... Registered Nurse (RN) is the U.S. term for a professional nurse who is licensed and registered. ... A social worker is a person employed in the administration of charity, social service, welfare, and poverty agencies, advocacy, or religious outreach programs. ... Hospice chaplains or geriatrics chaplains are, simply, chaplains often assigned by or working with hospitals, seminaries or volunteer organisations, that specialise in providing long-term spiritual care, especially to geriatric patients and those suffering from terminal illness. ... a family of Ouagadougou, Burkina Faso in 1997 Family is a Western term used to denote a domestic group of people, or a number of domestic groups linked through descent (demonstrated or stipulated) from a common ancestor, marriage or adoption. ...


In the UK palliative care services offer inpatient care, home care, day care, outpatients 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 with no restrictions on disease type or expected prognosis. However, hospice care under the Medicare Hospice Benefit, 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, however, 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. Because of the amount of individual contact, caregivers and patients often form lasting friendships yet consequently, caregivers may find themselves under severe emotional and physical strain. Opportunities for caregiver respite are some of the services hospices provide to promote caregiver well being. Respite may be for several hours or up to several days (the latter being done usually by placing the patient in a nursing home or in-patient hospice unit for several days). There are several definitions of caregivers or carers. ... Respite care is the temporary residential care for a patient with the intention of providing a break for the primary care givers. ... Rest home for seniors in Český Těšín, Czech Republic SNF redirects here. ...


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 wide range of care. This may range from managing the physical symptoms in patients receiving active treatment for cancer, through 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. If a patient dies, it is common for most hospice organizations to offer bereavement counseling to the patient's partner or family. Sad redirects here; for the three letter acronym, see SAD. Suffering is any unwanted condition and the corresponding negative emotion. ...


In the US, board certification for physicians in palliative care is through the American Board of Hospice and Palliative Medicine; 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.


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 sign-off the MHB and return to Medicare Part A and re-enroll in hospice at a later time.


Dealing with distress

The key to effective palliative care is to provide a safe way for the individual to address their physical and psychological distress, that is to say their total suffering, a concept first thought up by Dame Cicely Saunders, and now widely used, for instance by authors like Twycross or Woodruff[9]. Dealing with total suffering involves a broad range of concerns, starting with treating physical symptoms such as pain, nausea and breathlessness. The palliative care teams have become very skillful in prescribing drugs for physical symptoms, and have been instrumental in showing how drugs such as morphine can be used safely while maintaining a patient's full faculties and function. However, when a patient exhibits a physiological symptom, there are often psychological, social, or spiritual symptoms as well. The interdisciplinary team, which often includes a social worker or a counselor and a chaplain, can play a role in helping the patient and family cope globally with these symptoms, rather than depending on the medical/pharmacological interventions alone. Usually, a palliative care patient's concerns are pain, fears about the future, loss of independence, worries about their family, and feeling like a burden. While some patients will want to discuss psychological or spiritual concerns and some will not, it is fundamentally important to assess each individual and their partners and families need for this type of support. Denying an individual and their support system an opportunity to explore psychological or spiritual concerns is just as harmful as forcing them to deal with issues they either don't have or choose not to deal with. A social worker is a person employed in the administration of charity, social service, welfare, and poverty agencies, advocacy, or religious outreach programs. ...


Some charities for the hospice movement offer free, self learning online programmes covering all aspects of palliative care, including management of distress.[10]


Alternative medical treatments such as relaxation therapy,[11][12] massage,[13] music therapy,[14] and acupuncture[15] can relieve some cancer-related symptoms and other causes of suffering. Treatment that integrates complementary therapies with conventional cancer care is integrative oncology. It has been suggested that Complementary and alternative medicine be merged into this article or section. ... This article does not cite any references or sources. ... Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a qualified professional who has completed an approved music therapy program. ... Acupuncture chart from Hua Shou (fl. ...


See also

Elderly care or simply eldercare is the fulfillment of the special needs and requirements that are unique to senior citizens. ... Elisabeth Kübler-Ross Elisabeth Kübler-Ross, M.D. (July 8, 1926 – August 24, 2004) was a Swiss-born psychiatrist and the author of the groundbreaking book On Death and Dying, where she first discussed what is now known as the Kübler-Ross model. ... Hospice chaplains or geriatrics chaplains are, simply, chaplains often assigned by or working with hospitals, seminaries or volunteer organisations, that specialise in providing long-term spiritual care, especially to geriatric patients and those suffering from terminal illness. ... Medical Social Work is a sub-discipline of social work. ... Pain medicine is a branch of anaesthetics concerned with the treatment of acute and chronic pain. ... Patient safety is a relatively recent initiative in healthcare, emphasizing the reporting, analysis and prevention of medical error and adverse healthcare events. ... Symptomatic treatment is any medical therapy of a disease that only affects its symptoms, not its cause, i. ... Terminal sedation (also known as palliative sedation, slow euthanasia or sedation for intractable distress in the dying/of a dying patiënt) is the practice of inducing unconsciousness in a terminally ill person for the remainder of the persons life, usually by means of a continuous intravenous or subcutaneous...

Footnotes

  1. ^ WHO Definition of Palliative Care. World Health Organization. Retrieved on March 07, 2006.
  2. ^ Seymour, J. E; D. Clark, M. Winslow (2004). "Morphine use in cancer pain: from 'last resort' to 'gold standard'. Poster presentation at the Third research Forum of the European Association of Palliative Care.". Palliative Medicine 18 (4): 378. 
  3. ^ Center to Advance Palliative Care, www.capc.org
  4. ^ Joanne Lynn (2004). Sick to death and not going to take it anymore!: reforming health care for the last years of life. Berkeley: University of California Press, 72. ISBN 0-520-24300-5. 
  5. ^ Zerzan, J.; S. Stearns, L. Hanson (2000). "Access to palliative care and hospice in nursing homes". Journal of the American Medical Association 284: 2489 - 2494. 
  6. ^ 2007, Center to Advance Palliative Care
  7. ^ Walsh D, Gombeski W, Goldstein P, Hayes D, Armour M (1994). "Managing a palliative oncology program: the role of a business plan". J Pain Symptom Manage 9 (2): 109. PMID 7517428. 
  8. ^ Center to Advance Palliative Care, www.capc.org
  9. ^ See Existential pain — an entity, a provocation, or a challenge? in Journal of Pain Symptom and Management, Volume 27, Issue 3, Pages 241-250 (March 2004)
  10. ^ CLIP: Current Learning in Palliative Care. Online tutorials. Help the Hospices. Retrieved on March 07, 2006.
  11. ^ Integration of behavioral and relaxation approaches into the treatment of chronic pain and insomnia.. NIH Technology Assessment Panel on Integration of Behavioral and Relaxation Approaches into the Treatment of Chronic Pain and Insomnia. The Journal of the American Medical Association (archives) (1996). Retrieved on March 07, 2006.
  12. ^ Walker, Walker et al. (1999). Psychological, clinical and pathological effects of relaxation training and guided imagery during primary chemotherapy (abstract).. PubMed, National Center for Biotechnology Information (NCBI). Retrieved on March 07, 2006.
  13. ^ Grealish L, Lomasney A, Whiteman B. (2000). Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer (abstract).. PubMed, NCBI. Retrieved on March 07, 2006.
  14. ^ Cassileth, Vickers, Magill. (2003). Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial (abstract).. PubMed, NCBI. Retrieved on March 07, 2006.
  15. ^ David Alimi et al. (2003). Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial. Journal of Clinical Oncology. Retrieved on March 07, 2006.

March 7 is the 66th day of the year in the Gregorian Calendar (67th in Leap years). ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... March 7 is the 66th day of the year in the Gregorian Calendar (67th in Leap years). ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... March 7 is the 66th day of the year in the Gregorian Calendar (67th in Leap years). ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... March 7 is the 66th day of the year in the Gregorian Calendar (67th in Leap years). ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... March 7 is the 66th day of the year in the Gregorian Calendar (67th in Leap years). ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... March 7 is the 66th day of the year in the Gregorian Calendar (67th in Leap years). ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... March 7 is the 66th day of the year in the Gregorian Calendar (67th in Leap years). ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ...

External links


  Results from FactBites:
 
Palliative care - Wikipedia, the free encyclopedia (1600 words)
Palliative care (from Latin palliare, to cloak) is any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease or slows its progress rather than providing a cure.
calls palliative care "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness." In some cases, palliative treatments may be used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherapy.
Palliative care teams have become very skillful in prescribing drugs for physical symptoms, and have been instrumental in showing how drugs such as morphine can be used safely while maintaining a patient's full faculties and function.
Palliative care - definition of Palliative care in Encyclopedia (620 words)
Palliative care is any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease or slows its progress rather than providing a cure.
In some cases, palliative treatments may be used to alleviate the side effects of curative treatments, such as relieving the nausea associated with chemotherapy.
Major aspects of hospice care include the relief of pain (analgesia), as well as psychological help for patients and their families to cope with the impending death.
  More results at FactBites »

 
 

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