Overview of palliative care
What is palliative care?
Palliative care is an integrated approach that focuses on quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and treatment of pain and other problems, physical, psychosocial, and spiritual' (1).
This embraces the concept that quality care is embedded not only in individual health, but also the environment and setting of care and touches the domains included in the previous World Health Organization (WHO) definition. Palliative care focuses caregivers on the important goals of medicine—alleviating pain and suffering (at all levels), improving the experience of daily living, supporting psychological transitions with changing physical abilities, and advancing the patient's and family's understanding of the nature of the disease facing an individual and the outcomes (2). With that in mind, it represents a basic tenet of care for all patients, particularly those with diseases that lead to significant loss of quality of life and function. While this chapter focuses more on oncological palliative care, the tenets of palliative care and the research about symptom management can extend to the care of women with chronic conditions such as chronic pelvic pain, severe endometriosis, interstitial cystitis, untreatable pelvic prolapse, and other conditions. Palliative care, then, can be a focus for fatal and non-fatal diseases, and can and should be provided to address diminished quality-of-life issues as a part of ongoing treatment of a disease process, not just at the end of life.The therapeutic relationship
At the basis of the therapeutic relationship are trust and a reliable presence. It is essential that patients are able to trust that their physicians, nurses, and team will continue to care for their needs or advocate for what they need and not reject them as a patient even if there is no longer the possibility of a cure: this is in and of itself therapeutic.
Communication with patients and families and coordination of care are other cornerstones of the therapeutic relationship that underpins palliative care. Listening to patient's wishes, concerns, and making sure they are heard as a unique individual facing unique problems that we—t heir caregivers—are united in addressing, is the basis of setting therapeutic goals. Care for the dying or those dealing with chronic issues challenges healthcare givers to review their attitudes, communication styles, and beliefs. It also challenges healthcare givers to identify the areas where they may not have the most expertise and engage the interprofessional teams and experts who are needed to provide palliative care for their patients, even if it means they are no longer the primary health provider.In general, healthcare givers, particularly physicians, have not had the training to provide optimal palliative care although the evidence for efficacy and cost-effectiveness is well established (3, 4). Given the general lack of adequate numbers of palliative care specialists even in well-resourced settings, there is an obligation owed to patients for healthcare workers to be knowledgeable and informed in order to assure high-quality care of patients in need of palliative care.
Interdisciplinary care
Effective palliative care requires a team—usually a doctor, nurse, social worker, and others as needed, including dieticians, occupational therapists, physical therapists, and therapeutic massage. Use of the creative arts and music, spiritual support, psychologists, pain specialists, and disease experts should all be added to the mix of carers. Different communities use different healthcare providers, such as traditional healers, herbalists, acupuncture, and Ayurvedic medicine (among many others), and relationships with these diverse groups of healers should be pursued and respected. Not all settings will have all the elements that are needed, but the broader the perspectives and support that can be brought to bear, the better the ultimate palliation of symptoms and support for quality of life. Incorporating psychologists and spiritual care in particular helps address the family's as well as the patient's needs and the needs of the team itself to find meaning in the process of transcending suffering through palliative care including the process of dying.
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