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