Palliative Medicine and End-of-Life Care

The provided assignment is a comprehensive compilation of research papers, articles, and studies related to palliative medicine and end-of-life care. It covers topics such as opioid use, antidepressants, antiepileptic drugs, delirium management, and interprofessional collaboration in the community. The assignment also touches on factors considered important at the end of life by patients, families, physicians, and other caregivers. It aims to provide insights into the challenges professionals face in palliative care and strategies for better management.

Running head: Death and Dying
Death and Dying
-Palliative care
Name of the Student
Name of the University
Author Note

1Death and dying
Introduction:
Palliative care can be understood as a specialized type of medical care that is used for
patients suffering from serious illnesses. The care focuses to provide relief from the stress as
well as the symptoms of the disease, and also allow improvement in the quality of life of the
patients as well as their families. The care is usually provided by a team of trained healthcare
specialists like doctors, nurses and other support groups, and can be applicable at any age or
at any stage of the disease, and can be used along with any curative form of treatment
(getpalliativecare.org 2018. Palliative care can be provided in different types of setups like
hospitals, outpatient clinics, facilities of long term care and even at home under medical
supervision (cancer.gov. 2018).
The goal of this article is to review the literature regarding palliative care that
identifies the goals, principles and philosophies of care, discusses the different challenges in
the providence of palliative care to Australians, and also evaluates the medications that can
be used in the management of death, dying and bereavement.
Goals, principles and philosophies of palliative care
According to the World Health Organization, Palliative Care has the following goals:
 Relief from pain or other symptoms of the disease
 Affirming life and regarding death as a natural phenomenon
 Does not attempt to either quicken or delay death
 Involve both spiritual and psychological aspects of care
 Providing a support framework for the patients which can assist the patient in
leading an active life until death

2Death and dying
 Providing a support framework for the families to cope up with the illness of
the patient, and in the event of their death
 Involving a team to address the needs of the patients and their families
 Improving quality of life and influencing the development of the disease
(who.int 2018).
Bernacki and Block (2014) discussed the different care goals in the communication of
serious illness, identifying the best practices through a review of literature regarding
conversations about serious illnesses care goal. The guidelines are discussed below:
 Comprehension of Prognosis: An understanding of the prognosis should be explored
in order to ascertain the awareness and acceptance of the patient regarding their
condition (Sullivan et al. 2005; Alexander et al. 2006; Sullivan et al. 2006;
Fallowfield et al. 2002).
 Preference to information by the patient regarding their future regarding any decisions
and their involvement can help the professionals to provide the required information,
with the patient being in control and also can instil confidence in the healthcare
professional to proceed with treatment (Fallowfield et al. 2002)
 Disclosure of prognosis to the patient can be done to the degree desired by the patient
who can be useful for them to take decisions and also inform patients regarding what
to expect about their condition (Clayton et al. 2005; Steinhauser et al. 2000)
 Patient goals should be addressed in the care can help to address the despair and
hopelessness cause by serious illness (Clayton et al. 2005)
 Addressing fears about any future suffering caused by the disease (Larson and Tobin
2000)

3Death and dying
 Acceptable function and an acceptable limit of impairments caused by the disease, as
deemed by the patient should e considered in the decision making process (Clayton et
al. 2005)
 Trade-offs between various forms of management of treatment and the effect on
quality of life and time at home should be clarified (Fallowfield et al. 2002)
 Involvement of family as per patient’s request (Sulmasy et a. 2007)
The study also identified the various principles of end of life communication as:
 Providing truth about progress
 Not harming the patient by discussing end of life issues
 Accepting that anxiety is normal feeling
 Acknowledging that the patients can have other goals and priorities apart from
a long life
 Understanding the goals and priorities of the patients can help to provide a
better care (Bernacki and Block 2014).
Challenges of providing palliative care
Studies by Fitch et al. (2015) discussed the nursing perspectives of palliative care.
The study identifies nursing profession as integral in the promotion and providence of early
palliative care, which needs to be aligned with the basic tenants of nursing, providing holistic
care for patients and their families. The study points out few challenges related to palliative
care education. Financial Constraint is a problem faced by healthcare systems globally, which
further affects the availability of the service or access to it. A change in the attitude of the
patients, who show an increased intention of being in control of their condition as long as
possible, necessitates structuring advance care practices. However, several nurses feel
uncomfortable having the conversation regarding death, dying and end of life decisions of the
patients, like a desire for physician assisted suicide. It has been suggested that such situations

4Death and dying
can cause moral or emotional distress, vicarious trauma and compassion fatigue among the
nurses (Fitch et al. 2007; Vachon 2012).
Another challenge identified by Fitch et al. (2015) is the worldwide problem of
shortage of nursing professionals. However, such challenge also provides the scope of
creativity and improvises better models of care, and requires a transformational change in the
delivery of healthcare and involvement of multi disciplinary, inter-professionals healthcare
teams. Also, the short term nature the budgeting cycles and a deficit in leadership can also be
a significant challenge in the delivery of palliative care (Baker 2001). Fitch et al (2015) also
pointed out a decline in the number of young individuals joining the profession of nursing as
well as that lack of retention strategies for new nurses in healthcare organizations.
Studies by Clarke and Fasciano (2015) points out long term conditions among young
adults can lead to an increased disease burden and therefore continued clinical treatment
needs frequent assessment and promotion. This shows that palliative care for young adults
needs to incorporate treatment as well as long term care and assessment strategies. This has
also been supported by Oishi and Murtagh (2014) who proposed that two main challenges in
palliative care are: maintenance of continuity and coordination in care and dealing with
uncertainty (Lunney et al. 2003).
Medications of death, dying and bereavement
Physicians administering palliative medications also have to be involved in the
development of services, management of hospice as well as training, education and research.
It also requires several core competencies like: core medical care, acute care, anaesthesia,
core surgical knowledge, and general practice skills (jrcptb.org.uk 2018).

5Death and dying
The medications are administered to manage symptoms like nausea, pain, vomiting,
and depression or breathing difficulties. Palliative treatments like chemotherapy, hormone
therapy and radiotherapy are aimed to control or slow the progress of the disease instead of
eradicating it. The different classes of medications can include: analgesics (for pain
management), laxatives or aperients (for prevention or treatment of constipation), antiemetic
(for the prevention or treatment of nausea), adjuvant medication (used with analgesics to
manage pain or other symptoms), steroids (treatment of inflammation related symptoms),
antidepressants (to treat depression or even pain), neuroleptic medication (for anxiety,
depression and pain delirium) and sedatives (Caresearch.com.au 2018; Cherny and Christakis
2011; White et al. 2018; Kane et al. 2017; Bruera et al. 2015; Owens 2017; Hui et al. 2017).
It is important to consider that giving palliative medications should be simple and
non-traumatic as much as possible, and can be provided in a home setup, even if the route of
administration of the medication is different from that used in a conventional setup for care
like hospitals. Furthermore, it is also important for long term medications to be reviewed
frequently, especially for patients with multiple medical conditions that are unrelated to the
palliative care. This can help to understand the burden in terms of discomfort and cost of
multiple medications as well as the risks of drug interactions from polypharmacy. The
decisions should be made depending upon the prognosis from diagnosis of palliative care
with the risks (short term or long term) and stoppage of medication to treat co-morbid
conditions (Caresearch.com.au 2018).
Conclusion
Palliative care is a specialized type of treatment that is applicable for patients who are
suffering from serious, long term and usually fatal diseases. The care aims to promote the
well being of the patients through improving their quality of life, and also providing support

6Death and dying
to the families (of the patients) to cope up with the disease and also to help them to be
emotionally prepared for the death of the patient. Healthcare professionals in palliative care
and palliative medicine should furthermore be able to understand the prognosis of the disease,
and help the patient to understand the same. References of the patients should also be taken
into account regarding the future direction of their care, and any information or support
needed by the patient to undertake such decisions should also be provided. It is important to
acknowledge that the patients often go through anxiety; despair and even depression while
coping with their condition, and those patients often have goals apart from the treatment of
their conditions and living a long life. Moreover, the patients should be made aware about the
care plan as well as the possible outcomes of the care and its effects on the treatment on the
level of impairments faced by the patient. Also, apart from the clinical and medical
requirements, the psychological, emotional as well as spiritual needs of the patients also need
consideration in order to provide holistic care.

7Death and dying
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