What is palliative care?
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, psychosocial and spiritual.
Palliative Care Services
Palliative Care at home are for those people suffering from advanced life limiting conditions, including:
- Cancer
- Heart Failure
- Lung Disease
- Liver Failure
- Kidney Failure
- Multi Organ Failure
- AIDS
These palliative care services are provided by registered nurses, carers, physiotherapists, counsellors and social workers.
Palliative Care Service Provided For These Conditions
| Condition | Referral Criteria |
|---|---|
| Congestive Cardiac Failure | Symptoms despite maximal medical therapy disabling sob at rest (nyha iv) ≥5 admissions in past 6 months other associated organ involvement |
| Chronic Obstructive Pulmonary Disease | Disabling SOB at rest (NYHA class IV) ≥5 admissions in past 6 months Associated cardiac failure |
| Renal Failure | Not suitable/declined for dialysis End-stage renal disease (GFR <15 ml/min) (stage 5 CKD) Symptoms of renal failure (anorexia, nausea, pruritus, intractable fluid overload, decreased functionality) |
| Stroke | Severe disabling; Severe dysphagia Recurrent fever and sepsis |
| Cancer | Stage IV malignancy (metastatic) Not for (further) definitive treatment Spends >50% of time in bed |
| AIDS | Stage III or IV disease with dementia, cachexia, neoplasm or failure of HAART |
| Other | Intracranial haemorrhage not for surgical management/on ventilator Post cardiopulmonary arrest with CNS damage |
SOB – Shortness of breath
GFR – Glomerular filtration rate
HAART – Highly active antiretroviral therapy
NYHA – New York Heart Association
CKD – Chronic kidney disease
CNS – Central nervous system
Admission Criteria For Service
- Patient not expected to live longer than 6 months.
- Active treatments such as chemotherapy discontinued.
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Case study
A study (Van Niekerk, L and Raubenheimer, PJ: South African Medical Journal 2014, April, Volume 2, 138-141) conducted in Cape Town during November 2011 and January and February 2012, reviewed note of about 1, 500 patients in 11 government hospitals, and deduced from the medical notes that 16.6% of all patients were in fact receiving palliative care (end of life care). Palliative care was defined as patients who were not expected to live more than 12 months, and who were suffering from one of these end stage conditions: end stage cardiac failure, renal failure, lung disease, stroke, cancer, AIDS, intracranial bleed unfit for surgery, or were post cardiac arrest.
The above studies also demonstrate the great number of patients receiving palliative care in hospital. The majority could receive care at home. Indeed, palliative care patients want to be cared for during those lasts weeks and months in the comfort and dignity of their own homes. This is clearly demonstrated by review of a data base of 58 studies involving 13 countries and one and a half million patients: the majority wanted to be cared for at home, most especially when functional status was low, home care services were available and intense, patients were living with relatives, and patients wished to be at home (Gomes, B and Higginson, IJ 2006: British Medical Journal, 332515-521).