Posted: May 1st, 2024
Improving End-of-Life Care and thesiSymptom Management
Improving End-of-Life Care and Symptom Management
End-of-life care is the care provided to people with advanced or terminal illnesses who are approaching the end of their lives. The goal of end-of-life care is to improve the quality of life of patients and their families by addressing their physical, emotional, social and spiritual needs. Symptom management is an essential aspect of end-of-life care, as it aims to relieve the suffering caused by pain and other distressing symptoms that may affect patients’ comfort and dignity.
Symptoms that may occur at the end of life include pain, breathlessness, fatigue, nausea, vomiting, constipation, diarrhoea, anxiety, depression, confusion, delirium and agitation. These symptoms may have different causes and require different interventions depending on the patient’s condition, preferences and goals of care. Therefore, symptom management should be individualized, holistic and evidence-based.
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Some of the principles of effective symptom management in end-of-life care are:
– Assessing symptoms regularly and systematically using validated tools and scales
– Communicating with patients and families about their symptoms, expectations and concerns
– Involving patients and families in shared decision-making about treatment options and their risks and benefits
– Providing a coordinated, multidisciplinary approach that integrates medical, nursing, psychological, social and spiritual care
– Using pharmacological and non-pharmacological interventions as appropriate
– Evaluating the effectiveness and side effects of interventions and adjusting them as needed
– Addressing the psychological distress and coping strategies of patients and families
– Providing education and support to patients and families on how to manage symptoms at home
– Referring patients to specialist palliative care services when needed
Some of the challenges of symptom management in end-of-life care are:
– Lack of knowledge and skills among health professionals on how to assess and treat symptoms
– Lack of availability and accessibility of medications, equipment and services for symptom relief
– Lack of communication and coordination among health professionals, patients and families
– Lack of understanding and acceptance of palliative care principles and goals among patients and families
– Cultural, religious and ethical issues that may influence symptom management decisions
– Legal and regulatory barriers that may limit the use of opioids and other medications for pain relief
To overcome these challenges, there is a need for more research on the best methods for managing symptoms at the end of life, as well as more education and training for health professionals, patients and families on palliative care. There is also a need for more advocacy and policy changes to improve the availability and quality of end-of-life care services.
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References:
– Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of patients’, carers’ and health professionals’ experiences and further research questions. Baillie J et al. BMC Palliative Care 2018; 17: 60. https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-018-0314-4
– Conceptualising effective symptom management in palliative care: a novel model derived from qualitative data. Chapman EJ et al. BMC Palliative Care 2022; 21: 17. https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-022-00904-9
– Care at the End of Life: Palliative and Hospice Care—Symptom Management in Palliative Care. Kuebler KK et al. In: Palliative Care Nursing: Quality Care to the End of Life (5th ed.). Springer 2023; pp. 85–106. https://link.springer.com/chapter/10.1007/978-3-031-15353-2_5
– Managing pain and other symptoms. NHS website. Accessed on 13 January 2024. https://www.nhs.uk/conditions/end-of-life-care/your-wellbeing/controlling-pain-and-other-symptoms/
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