Palliative Care

Palliative care is a field of medicine involving a multidisciplinary approach to patients with serious illness/illnesses. It focuses on pain and symptom control rather than curative outcome. The main goal is to improve the quality of life for both patient and family. In all patients with terminal illnesses the principles of palliative care can be applied. It does not need to be limited to cancer patients.

Dyspnea

 * History, physical, +/- Investigations
 * Treat reversible causes, if align with patient goals
 * Oxygen is only helpful for relief of hypoxemia
 * Comfort measures: positioning, fan, relaxation, lifestyle modification, energy conservation and breathing control
 * Pharmacotherapy:
 * Opioids:
 * Morphine 2.5-5 mg PO q4 hours or Morphine 1-2mg SQ q4 hours
 * Breakthrough dose (1/2 regular q4 hour dosing, given q1hourPRN)
 * Can use other opioid equivalent
 * When starting: initiate bowel protocol for constipation and manage nausea
 * Benzodiazepine:
 * Crisis dyspnea: opioid + benzo

I2 In patients requiring palliative care, provide support through self, other related disciplines, or community agencies, depending on patient needs (i.e.., use a team approach when necessary). Patient Centered Treatment 3 In patients approaching the end of life: a) Identify the individual issues important to the patient, including physical issues (e.g., dyspnea, pain, constipation, nausea), emotional issues, social issues (e.g., guardianship, wills, finances), and spiritual issues. Patient Centered Clinical Reasoning History b) Attempt to address the issues identified as important to the patient. Patient Centered Clinical Reasoning Treatment 4 In patients with pain, manage it (e.g., adjust dosages, change analgesics) proactively through: - frequent reassessments. - monitoring of drug side effects (e.g., nausea, constipation, cognitive impairment). Clinical Reasoning Treatment Follow-up 5 In patients diagnosed with a terminal illness, identify and repeatedly clarify wishes about end-of-life issues (e.g., wishes for treatment of infections, intubation, dying at home)