THE PROCESS OF PROVIDING PALLIATIVE CARE

The steps involved in the palliative care therapeutic process that guides the interactions between health professionals, patient and families.


1. ASSESSMENT

  • Patient and family history – including presenting problems and current, past and potential issues.

  • Physical examination if required

  • Has there been any recent treatments, investigations or procedures?

  • What social structures and supports are in place? How do the family function? – family or carers, other support structures (health, community), health issues for family or carers, functional/practical issues, financial issues

  • Psychological and emotional responses to the illness and its effects; what was the pre-illness personality and how did they usually manage and cope, fears, anxiety, understanding, concerns for family, previous psychological/psychiatric issues, Intelligence, cognition, needs (intervention/counselling/ medication).

  • Spirituality/religious beliefs – existential concerns, spiritual/religious needs, rites or rituals, religious paraphernalia, staff awareness/knowledge of these needs and where to seek help.

  • Expectations regarding the care and the outcomes from the contact

  • Are there any priorities of care for the patient or family

  • The use of tools such as the RUG-ADL, AKPS, Needs Assessment Tool and the mFIN to assess what care may be required.

  • What is the complexity of the care that is, or that may be, required.


2. COMMUNICATION

  • The patient and family’s understanding of the illness and its actual or potential impact on both

  • What information they require?

  • How prepared they are for this information?

  • To manage how the information should be provided.

  • To determine when and where the information should be provided

  • Who information can be or should be shared with.

  • How they respond to the information provided?

  • The understanding of what has been provided.

  • Is there a need for additional information>

  • Is a translator or translation of information required?

  • Has consent to share information been given?


3 . DECISION MAKING

  • What is the capacity of the patient and family to make any decisions?

  • Have the goals of care been determined?

  • Are there any priorities for the care that is required?

  • What are the treatment options available and what are the benefits, risks and burdens associated with these?

  • What are the treatment choices?

  • Has consent for treatment been obtained?

  • Have there been any requests to withhold or withdraw therapy?

  • Have there been any requests to be given therapy that offers no benefit?

  • Requests to hasten death?

  • Have “Advance directives” been recorded?

  • If there is conflict is it possible to resolve this?

  • Legal guardianship/Surrogate decision making/Power of attorney


4. CARE PLANNING

  • Negotiation of process of plan of care that includes:

        • Discussion about the issues

        • Ways to deal with these issues.

        • Treatment options to manage the issues.

  • What type of care is required?

  • Who should provide the care?

  • Where the care should be provided?

  • Have the needs of both the family and or carers been factored into the plan?

        • Support(s)

        • Respite

        • Dealing with emergencies

        • Discharge planning

        • Terminal Care

        • Bereavement


5. CARE DELIVERY

  • Determine the composition of the team(s) required to provide the care.

        • Based on the level of need and complexity of the care.

        • Do family members have any role in the provision of care.

  • Coordination and leadership of the team(s) involved in the care.

  • Education and training requirements of the care team

  • Education and training needs of the family/carers.

  • Is any support required by the team providing the care?

  • What support is required by the family/carers?

  • Where is the care going to be provided and is this likely to change at any time due to the patients or family’s requirements?

  • What services are essential and what services may have a supportive role?

  • Practical issues related to the care eg supply/storage of equipment, dealing with infectious wastes.

  • Management/Administrative issues

  • Quality improvement


6. ENDORSEMENT OF THE PLAN

  • How able are the patient and family to participate in the care planning?

  • What is everyone’s understanding – including health carers - of what is discussed and decided upon?

  • Are there any additional questions or issues which need to be addressed

  • Is everyone satisfied with the plan of car?

  • Does the plan of care cause distress to anyone in the group?

  • How complex is the care required and what are the implications both for the patient and family and for the health care staff?

IKA SYAMSUL HUDA MZ