Palliative care in intensive care environments

2016 ◽  
Author(s):  
Richard D.W. Hain ◽  
Satbir Singh Jassal
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Symptom Management ◽  
Paediatric Intensive Care Unit ◽  
Significant Proportion ◽  
Care Planning ◽  
Care Environment ◽  
Care Services ◽  
Palliative Care Services ◽  
Significant Attention

A significant proportion of deaths in childhood, even those from life-limiting conditions, happen in an intensive care environment. An effective interface between palliative care services and the neonatal or paediatric intensive care unit is important but also presents certain specific challenges. This chapter looks at some of these challenges. It covers advance emergency care planning and compassionate extubation, examining the practicalities, symptom management, and parallel planning involved in this stage of care. Significant attention is also given to the ethics of compassionate extubation and symptoms during compassionate extubation.

Integration of specialist palliative care services into a multidisciplinary adolescent and young adult (AYA) oncology team.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 64-64
Author(s):  
Rachel Elizabeth Hughes ◽  
Kate Thompson
Keyword(s):  
Palliative Care ◽  
Young Adult ◽  
Clinical Oncology ◽  
Symptom Management ◽  
Symptom Burden ◽  
Multidisciplinary Care ◽  
Adolescent And Young Adult ◽  
Curative Intent ◽  
Care Services ◽  
Palliative Care Services

64 Background: Palliative care is recommended alongside standard oncological care for patients with advanced cancer or high symptom burden (Smith TJ, Temin S, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of Clinical Oncology. 2012;30(8)880-7.). AYA oncology patients are distinguished by several age-specific developmental and biopsychosocial factors, resulting in a unique impact profile (Wein S, Pery S, Zer A. Role of palliative care in adolescent and young adult oncology. J Clin Oncol. 2010;28:4819-4824). Methods: To examine the benefits of multidisciplinary AYA care, a palliative care fellow was incorporated into an existing AYA oncology team in Australia, for a 12 month period. This role facilitated assessment/management of symptoms, general health issues, treatment toxicity, end of life care and bereavement support. Results: Between 2012 and 2013, of 83 new patients were referred to the AYA oncology service, 27 (32.5%) were referred the palliative care fellow. Notably, 37% of patients referred were receiving curative intent treatment. 10 patients (37%) were referred at diagnosis for symptom management. Pain was the most frequent reason for referral (n=17 63%). A total of 7 patients (26%) were referred for advanced disease/terminal care. Conclusions: Evaluation demonstrates that onsite availability of palliative care services is acceptable, facilitates early referral and has encouraged collaborative, AYA multidisciplinary care. A significant additional finding has been recognition of the demand for symptom management of patients early in their cancer experience. Further development and evaluation of AYA specific palliative care is warranted.

scholarly journals Advance care planning in palliative care: a national survey of health professionals and service managers

2015 ◽  
Vol 39 (2) ◽  
pp. 146 ◽  
Author(s):  
Marcus Sellars ◽  
William Silvester ◽  
Malcolm Masso ◽  
Claire E. Johnson
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
National Survey ◽  
Health Professionals ◽  
Care Planning ◽  
The Past ◽  
Care Services ◽  
Palliative Care Services ◽  
Advance Care ◽  
Service Managers

Objective To identify the attitudes, knowledge and practices regarding advance care planning (ACP) in palliative care. Methods A nationwide online survey was distributed to Australian palliative care services associated with the Palliative Care Outcomes Collaboration (n = 105). Seventy-three health professionals (HPs) and 59 service managers completed the survey. Results Regarding ACP, 51% of service managers reported relevant policies and procedures were in place in their service and 44% included ACP in job descriptions. Most HPs were confident in undertaking ACP, including initiating discussions with patients and complying with documents; however, only 44% reported receiving ACP specific training. Although 58% of HPs reported having conversations about ACP with more than 11 patients in the past 6 months, only 44% of managers report that it is offered to most patients. Thirty per cent of HPs were aware of others not adhering to patient wishes in the past 6 months and only 43% of HPs (and 37% of managers) believed ACP is done well within their service. Conclusions This first national survey examining ACP in palliative care services demonstrates there is a need to improve systems to support ACP and to understand circumstances in which ACP wishes are not followed. What is known about the topic? ACP is increasingly recognised as an important part of care of people in hospital and community settings. However, currently there is no empirical evidence about the national uptake and quality of ACP in palliative care settings specifically. What does this paper add? This nationwide survey shows improvements on past small-scale research showing that ACP is supported by palliative care health professionals; however, the organisational ACP processes and systems did not support best practice in this regard. What are the implications for practitioners? Palliative care organisations should incorporate ACP systems (including greater access to ACP policies and guidelines) that support health professionals to complete ACP with clients who want to. Greater access to support, such as ACP training and resources, would assist with development of ACP documentation and adherence.

Effect of intervention on quality measures of symptom management in the Michigan Oncology Quality Consortium (MOQC).

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 70-70 ◽  
Author(s):  
Jeffrey B. Smerage ◽  
Katie Abstoss ◽  
Jane Severson ◽  
J. Cameron Muir ◽  
Claudia Jane Martin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Lessons Learned ◽  
Care Services ◽  
Training Materials ◽  
Palliative Care Services ◽  
Oncology Care ◽  
Specific Care ◽  
Oncology Practice ◽  
Scale 8

70 Background: Michigan oncology practice groups that participated in MOQC [JOP 5(6):281, 2009] used the Quality Oncology Practice Initiative (QOPI) tool. Adherence to processes of disease specific care was high, but poor in domains associated with palliative care. These measures did not change over time [Health Affairs. 31(4):718, 2012]. These findings prompted us to test interventions to improve quality in palliative care domains. Methods: MOQC created a process, based on the IHI Framework for Spread, to assist oncology practice groups in establishing their own primary Palliative Care services, including the implementation of Edmonton Symptom Management Scale. 8 practice groups formed teams of local change agents to participate in the Palliative Care Demonstration (PC Demo) project. The teams participated in 3 in-person and 4 online learning sessions over 8 months, led by palliative care and quality experts. Teams were provided tools, training materials, and necessary support to implement the improvements and measure their success. The learning network facilitated the sharing of best practices and lessons learned throughout the process. The teams presented their results broadly to other MOQC participants at project conclusion. Results: Success was measured using palliative care-focused ASCO QOPI results. PC Demo sites consecutively improved their scores in many of the QOPI measures, and their rate of improvement from Fall 2011 to Spring 2012 was greater than that of their peers. Conclusions: We observed that collecting and distributing data in our consortium was insufficient to improve palliative oncology care. Providing practice groups with the appropriate infrastructure improved their capacity and capability to make the necessary changes to improve performance. [Table: see text]

Intensive care units

2021 ◽  
pp. 332-340
Author(s):  
Brian S. Carter
Keyword(s):  
Palliative Care ◽  
Intensive Care ◽  
Symptom Management ◽  
Paediatric Intensive Care Unit ◽  
Healthcare Service ◽  
Advanced Technology ◽  
Children And Families ◽  
Palliative Care Teams ◽  
The One

The goals of intensive care and palliative care teams may at first seem to be polar opposites. The one focuses on advanced technologies directed towards saving or prolonging life, while the other focuses on providing comfort and support, accepting death as a likely outcome. In caring for patients in the paediatric intensive care unit (PICU), however, those two teams are brought into a close working relationship. PCIU provides a natural interface for these teams with different goals. Here children and families face potential or inevitable death, and alongside attempts to save or prolong life, they need access to the kind of care that is at the heart of palliation. Where PICU and palliative care meet, children can receive the most advanced technology alongside skilled, holistic, supportive care, and both teams can work together with families to facilitate appropriate support as goals change. Palliative care is not a separate or different approach, but a continuation of the philosophy that medicine must only intervene in ways that will do more good than harm. Palliative care continues to be integrated into the care of patients and families in both the neonatal and PICU settings. With focused research aimed at healthcare service delivery, effective symptom management, and the role of palliative care consultants in the PICU, the potential to broaden and improve palliative care in the PICU will be further advanced for all children and their families. The surprise is not that these two services should be integrated, but rather that it has taken us so long to realize the importance of such integration.

Renal failure

2019 ◽  
pp. 547-560
Keyword(s):  
Palliative Care ◽  
Renal Failure ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Symptom Management ◽  
End Stage Renal Failure ◽  
Care Services ◽  
Palliative Care Services ◽  
End Stage

This chapter describes the issues associated with providing palliative care to patients with renal failure, and covers initiation of renal replacement therapy, conservative treatment, symptom management for patients with advanced renal disease, and issues surrounding stopping renal replacement therapy. As obesity and diabetes increase, so does the incidence of chronic renal disease and end-stage renal failure. Determining the exact number of patients dying of renal failure is challenging. Often the cause of death will be ascribed to an associated contributing factor, e.g. diabetes mellitus, or the final acute event resulting in death, e.g. myocardial infarction. However, we know that renal failure is an independent risk factor for cardiovascular disease and is associated with a high all-cause mortality.1 In addition, patients with end-stage renal failure have a significant symptom burden and therefore it is important that patients have access to palliative care services to assist with symptom management, advanced care planning, and, where appropriate, decisions around dialysis and transplantation.

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