8 Domains of Palliative Care
- Structure and process of care: assure interdisciplinary assessment of patient/family, develop plan based on needs/goals of patient, provides care across the care continuum
- Physical: obtain history and do physical exam, manage side effects based on best medical evidence, treat to minimize symptoms and maximize quality of life
- Psychological and psychiatric: respond to psychological and social problems from patients/family, provide bereavement support to family
- Social: identify social needs of patients and family, transportation and financial problems, stress of family caregivers
- Religious, spiritual, and existential: FICA
- Cultural
- The imminently dying patient
- Ethics and law
Palliative Care
Improves the quality of life for patients and their family
Focuses on prevention and relief of suffering
Assessment of treatment and pain is multifaceted
Applicable early in course of illness
Interdisciplinary vs. Multidisciplinary
Multidisciplinary: involves consultations with people of different expertise
Interdisciplinary: working together as a team to create individualized plan to care for patient
Taking a spiritual history
FICA
F: faith and belief, do you consider yourself spiritual, if no then what gives your life meaning
I: importance, how has your beliefs influenced how you take care of this illness
C: community
A: address in care, how should I address your spiritual care
Signs and symptoms of imminent death
Social withdrawal: from outside world then loved ones
Decreased appetite
Increased sleep
Disorientation
Restlessness
Decreased sensorium: hearing is one of last to go
Incontinence
Physical changes: stuff like change in blood pressure and respiration
Hospice
Medicare benefit provided in last 6 months of life, form of palliative care
Palliative care can be done at any time
