Palliative care: A holistic approach to improve quality of life for patients

Palliative care is an age-old tradition where people in any stage of their disease can be treated with a holistic approach. It is specialized care to improve the quality of life of patients and their families, who are facing problems and challenges associated with life-threatening illnesses, which can be physical, psychological, social or spiritual.

Unlike mainstream hospitals, here the treatment involves more than just medications. It helps the patient and their loved ones pass through challenging times. Spiritual, mental, psychosocial, musical and other sessions are carried out by the professionals at the palliative care centre. Such activities keep the patient active and positive while they are suffering from a life-threatening condition. Bereavement counseling sessions are conducted for the family members as it is a difficult time for them to cope with the scenario of their dear ones.

How is it done?
It is managed by a team of pain and palliative care specialists, along with other specialists/super specialists, psychologists, rehabilitation specialists, physiotherapists, palliative care nurses and support staff. An initial assessment is done in the OPD to understand the disease profile of the patient, their distressing symptoms and other related psychological, spiritual and social problems. The need for involving other members of the palliative care team in counselling and rehabilitation is also evaluated.

As soon as the patient becomes comfortable with indoor palliative care, discharge time is planned in consultation with the patient and the family members. Finally, the team members decide whether Palliative care can be given at home, in OPD, Daycare Center or in the wards. Family members/caretakers are also trained to create adequate infrastructure at home to fulfil their needs of medication/ oxygen/ tube feeding/ urinary catheters/ colostomy care etc. A personalized follow-up care programme and consultation with treating doctors are explained and counselled to implement it.

Who all are a part of it?
Palliative care is teamwork, where hierarchy is minimized and each team member is empowered to provide the best possible care in an environment of mutual trust and respect. Coordination is the most important part of teamwork. The palliative care team includes:

1. Palliative medicine consultants (supported by all other specialists and superspecialists)
2. Resident doctors
3. Palliative care nurses
4. Nursing aids and other support staff
5. Psychologists
6. Social workers
7. Physiotherapists, pharmacists, dieticians
8. Spiritual Gurus
9. Family members /friends/ paid caretakers

What diseases is the palliative care facility applicable in?
Patients suffering from the below conditions can be healed at a palliative care centre:

1. Late stage cancer
2. Chronic obstructive lung disease
3. End-stage heart, liver and kidney failure
4. Alzheimer, Parkinson’s Disease, Dementia, Strokes, Paralysis
5. Disabilities due to ageing fall, accidents
6. Musculoskeletal problems, rheumatoid arthritis

How can these conditions be treated? How helpful is palliative care in chronic conditions?

1. Relieves pain and other physical symptoms.
2. Relieves emotional, psychological and spiritual problems
3. Improves quality of life, interpersonal relations and survival rates.
4. Helps in developing a positive attitude, after accepting the normal course of the disease and its progression.
5. Makes people understand that with willpower and medical support, patients can regain their normal lifestyle, and live symptom-free, comfortable, independent and dignified life for years to decades as far as possible.
6. Trains the family members/caretakers to manage the patient at home in consultation with the multidisciplinary team of the palliative care centre.
7. Saves money and time being spent on unnecessary investigations, procedures, admissions, ICU care and ventilator care, by shifting the focus from disease to the patient and from curing to healing.

What is the role of the doctor in this?
The role of a doctor in palliative care is most important to provide comprehensive pain management or symptom management to individuals with serious or life-limiting illnesses. This includes assessing and managing physical symptoms, such as pain, as well as providing psychological and emotional support to both the patient and their family. Palliative Care doctors work closely with a Multidisciplinary Palliative Care team, to develop a personalized care plan that meets the patient's individual needs and goals, by shifting the focus from disease to the patient and from curing to healing.

Conclusion
When an elderly patient is suffering from an end-stage condition, you would want to spend every second with them. This is the right thing to do, but so is to arrange a holistic treatment method to look after them. Maintaining routine tasks when suffering from chronic conditions is not an easy task and often leaves the patient mentally frustrated. They might not even have the urge to ask for support or help. Hence, facilities like palliative care have trained professionals and volunteers to make such patients’ suffering manageable. Many people are yet unaware of palliative care but it is an age-old practice and has been in our tradition for a long time. Let us take advantage of such facilities for our loved ones to make their life better during challenges.