Myths and Facts of Palliative Care from TMC

via The Medical City |

Palliative care is a special kind of patient- and family-centered health care that focuses on early identification and impeccable assessment and effective management of pain and other distressing symptoms, while incorporating psychosocial and spiritual care according to patient/family needs, values, beliefs, and others.

The goal of palliative care is to anticipate, prevent, and reduce suffering regardless of the stage of the disease or the need for other therapies. Palliative care supports the best possible quality of life for the patient and their family. Palliative care can be delivered concurrently with disease-directed, life-prolonging therapies. When palliative care begins at diagnosis, it facilitates patient autonomy, access to information, and choice.

However, when disease-directed, life-prolonging therapies are no longer effective, appropriate, or desired, palliative care already becomes the main focus of care.

Optimizing Quality of Life!

Palliative care is not a one-size-fits-all approach. Patients have a range of diseases and respond differently to treatment options. A key benefit of palliative care is that it customizes treatment to meet the individual needs of each patient.

Palliative care relieves symptoms such as pain, shortness of breath, fatigue, constipation, nausea, loss of appetite and difficulty sleeping. It helps patients gain the strength to carry on with daily life. It improves the ability to tolerate medical treatments. And it helps them better understand their choices for care. Overall, palliative care offers patients the best possible quality of life during their illness.

Palliative care benefits both patients and their families. Along with symptom management, communication and support for the family are the main goals.

Provided by a team

Usually a team of experts, including palliative care doctors, other specialists, and nurses, provides this type of care. Chaplains, physical therapists, nutritionists, and others might also be part of the team. Working in partnership with your attending physician, the palliative care team provides:

  • Expert treatment of distressing symptoms of advanced cancer and other illness
  • Close, clear communication
  • Guidance with difficult and complex treatment choices
  • Detailed practical information and assistance
  • Emotional and spiritual support for you and your family

Myths vs. Facts about Palliative Care

MYTH: Choosing palliative care means my doctors and/or family are “giving up” on me.

FACT: When a cure is no longer possible, supportive and palliative care provides the type of care most people say they want at the end of life – comfort and quality of life. The most common statement made by families who chose palliative care for their loved one is, “we wish we had known about palliative care sooner.”

MYTH: Palliative care means no more treatment.

FACT: When a palliative care team is called into a case or it is asked to take over the care of a patient, treatment does not automatically stop. Treatment and therapies can continue, but they have a different goal. For example, if a patient has advanced cancer, palliative surgery, chemotherapy, and/or radiotherapy may still be offered. However, these palliative treatments are not to cure the cancer, but to help remove or shrink the tumor that is causing pain or discomfort.

MYTH: Supportive and palliative care is for people with cancer or for old people.

FACT: Supportive and palliative care is for all ages who are living with a persistent or recurring condition that adversely affects their daily functioning or will predictable reduce life expectancy. Children and adults with congenital injuries, those with acute, serious, and life-threatening illnesses, those with chronic and life-limiting injuries, seriously and terminally ill patients, and those with progressive chronic conditions can benefit from palliative care.

MYTH: Having palliative care means you will die soon.

FACT: Palliative care is not offered according to the amount of time a patient has left. Palliative care is highly specialized and tailored to each individual, to ensure the highest quality o life possible to live each day until the end. In addition, palliative care utilizes complementary therapies such as music and art, and provides emotional and spiritual support to the terminally-ill person and loved ones, including grief therapy and bereavement support for the family afterwards.

MYTH:  Pain is an expected part of the dying process.

FACT: Even though the patient may be dying, supportive and palliative care doctors, oncology and pain nurses, and others are specially trained to control the patient’s pain, while still keeping the patient awake and alert whenever possible.

MYTH: Palliative care manages pain and other distressing symptoms through the use of addictive narcotics or opioids, and you sleep until you die.

FACT: Pain and distress are big issues in palliative care. If the disease cause moderate to severe pain and/or breathlessness, the patient may be treated with narcotics or opioids, but only if the patient needs it and only at the dosages they are needed. Proper doses of narcotics or opioids usually do not cause someone to stop breathing or to sleep until he/she dies. The goal of palliative care is not to dope the patient up or to perform “mercy-killing,” but to make the patient as comfortable as possible.

MYTH: Palliative care can only be provided in a hospital or hospice setting.

FACT: Palliative care is not a place, but a philosophy of care. Palliative care services are offered not only in hospitals or hospices, but also in the patient’s own home, where the person can be surrounded by family and familiar settings.

MYTH: If I choose supportive and palliative care, I’ll have to give up on my own doctor(s).

FACT: Patients in palliative care remain under the care of their own physician(s). working hand in hand with the palliative care team, the attending physician continues to play the essential role of clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan.

MYTH: Palliative care won’t allow me or my family to be involved in making decisions about treatment.

FACT: Palliative care puts patients and families at the center of care. Trained professionals provide guidance and encourage open, honest communication about individual wishes and choices.

MYTH: Only those with private insurance will be able to afford palliative care.

FACT: Palliative care physicians are accredited by Philhealth. They give senior citizen’s discount. Since the focus of care has shifted to comfort measures, the palliative care physician helps the family cut down expenses arising from futile diagnostics and therapeutics at the end-of-life.

Morphine: Myths and Facts

Here are some common misunderstandings about Morphine and other opiates:

MYTH: “If I take Morphine I won’t able to stop – I will become addicted.”

FACT: Very few people who use opiates for pain relief ever become addicted or “psychologically dependent.” However, it is important to be aware that anyone taking opiates for more than 2 weeks should not stop taking them all at once. They should ask their doctor about weaning off so that their body is able top adjust.

MYTH: “If I take Morphine now, it won’t work later on when my pain is worse and I really need it.”

FACT: There is no ceiling for the amount of Morphine that can be used safely, and there is no reason to wait until your pain is unbearable. If your pain increases over time, your Morphine dose can be increased as needed.

MYTH: “I’ve heard that Morphine has lots of side effects, and I feel bad enough already.”

FACT: All opiates can cause nausea, drowsiness and constipation. However, all side effects will generally stop after a few days, as your body adjusts, and constipation can be easily treated.

MYTH: “My doctor recommended Morphine, but that was what my father took just before he died – is the doctor not telling me something?”

FACT: Opiates are excellent drugs for treating moderate to severe pain. If you have an illness that is causing acute or chronic pain that is not adequately reduced by paracetamol or ibuprofen, talk to your doctor about using opiates. Morphine (and other opiates) is NOT just for people who are dying.

If you are living with untreated pain, ask your palliative care doctor what more can be done.

Myths and Facts of “Do Not Resuscitate” (DNR) & “Cardiopulmonary Resuscitation” (CPR)

MYTH: DNR equals “Do Not Care.”

FACT: A DNR order means absolutely everything will be done up to the point that the patient is found to be in the active dying process. Labs and tests will be done. Antibiotics will be ordered. Patients will go to the hospital. If the person or patient wants more specific orders to indicate they want “comfort measures only,” such as “Do Not Transfer to ICU,” “Do Not Give IV Antibiotics,” etc., these must be individually specified and have absolutely nothing to do with a DNR order. DNR pertains ONLY to the active dying process and not to any other stage.

MYTH: CPR is usually successful.

FACT: On television, CPR is often depicted as the ultimate life-saving technique. CPR frequently can save a person’s life, particularly in the case of some kinds of heart attacks and accidents an otherwise healthy person may experience. CPR is also most successful when the failure of heartbeat and breathing occur in the hospital, in the Cardiac Care Unit (CCU). Doctors and nurses in the unit will instantly recognize the problem and begin sophisticated care. However, when a person is in failing health from a serious and progressive illness, the heart and breathing will ultimately fail as a result of that illness. In such a circumstance, there is little chance that CPR will succeed at all. Any success will be temporary at best because the person’s weakened condition will soon cause the heartbeat and breathing to fail again.

Another possibility is that CPR may be only partially successful. If the heartbeat is restored but a person is still too weak to breathe on his or her own and remains too weak to do so, he or she may be on a ventilator for days, weeks, months or longer. Moreover, when breathing or heartbeat fails, the brain is rapidly deprived of oxygen. As a result, within seconds, the brain begins to fail (one loses consciousness), and within a very few minutes permanent damage to the brain occurs. If it takes more than those very few minutes to start effective CPR, the person will not fully recover. The brain damage may mean anything from some mental slowing and loss of memory to complete and permanent unconsciousness and dependency on a ventilator and sophisticate medical life support.

MYTH: CPR can’t hurt.

FACT: Television does not show the CPR process quite accurately – in real life the process is more brutal. Pushing the center of the chest down about one and one-half inches, 100 times a minute for several minutes, causes pain, and may even break ribs, damage the liver, or create other significant problems. CPR produces a barely adequate heartbeat, and doing it more gently is not sufficient to circulate enough blood. Electric shocks and a tube in the throat are also harsh treatments, but may be essential to resuscitate someone.

MYTH: “Doing everything” means we need to do CPR.

FACT: “Doing everything” means doing everything that is right medically and ethically for that patient at that time. At different times in a patient’s life, different medical interventions are appropriate. It is normal instinctive, to try to save life n matter what, and some people are concerned that not doing everything possible to preserve life is the same as “killing” someone. But it can also simply mean respecting the end stage of a disease as the body shuts down and death naturally occurs.

MYTH: DNR means that we are abandoning the patient or not providing him or her with every opportunity of life.

FACT: Again nothing could be further from the truth. There are times when it may not make sense to perform CPR. As an illness progresses, there usually comes a time when continued treatment will no longer reduce symptoms nor heal the person and he/she is in an end stage of the disease. Under these circumstances, there is little reason to attempt CPR, as CPR may only prolong dying at this point. At most, the effort might put the sick person in the hospital, in pain and distress, for the last days of his or her life. Having a DNR prepared may relieve the family members of making a decision to turn off a machine, which can be an even more difficult decision psychologically.

The more thoroughly family members have discussed these issues in advance of the need to make a critical decision, the easier it will be on both the person who is ill and those responsible for that person’s care. It is never too soon to start the conversation. Palliative care can relieve suffering and provide support to patients and families facing these big decisions.

If you are living with untreated pain, ask your palliative care doctor what more can be done.

Speak to your palliative care team led by your attending physician and have a meaningful

discussion regarding your loved one’s prognosis and the ability of CPR to be successful. In this way, you can come to both an intelligent and a correct ethical decision regarding DNR. DNR is a about doing the right thing medically and morally. It is not about giving up, but giving the best choice.

How can The Medical City help you?

The Medical City offers a roster of competent palliative care specialists who may assess andtreat pain and distressing symptoms undergone by people with chronic and life-limiting diseases, as well as provide psychosocial support and spiritual care not only for patients, but for their family as well.

Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.

For more information, please call:

THE MEDICAL CITY
CANCER CENTER
Tel. No. (632) 988-1000 / (632) 988-7000 ext. 6214

CENTER FOR PATIENT PARTNERSHIP
Tel. No. (632) 988-1000 / (632) 988-7000 ext. 6444

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