06 Palliative care
How might we improve a palliative patient’s course of illness?
Palliative care is an approach that intend to improve the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
Palliative care provides relief from pain and other distressing symptoms. Palliative care integrates the psychological and spiritual aspects of patient care, and it offers a support system to help patients live as actively as possible until death. Palliative care offers a support system to help the family cope during the patients’ illness and in their own bereavement, and it uses a team approach to address the needs of patients and their families.
Most terminally ill patients wish to die at home. But it only happens to ¼ of the patients. Many terminally ill patients experience their last time with acute admissions, and unclear communication between the hospital, their doctor, the palliative team and homecare.
A 68-year-old man suffers from incurable bowel cancer. He used to work as a mechanic. He lives in a one-story house with a healthy spouse. They have two grown-up daughters.
He is discharged from the hospital after he has had an ostomy.
At discharge he is associated Palliative team and the home nursing care. He gets parenteral nutrition. For pain he receives morfika, Tbl Contalgin 20 mg two times a day. If he needs it he can get extra morfika and paracetamol.
Two weeks after discharge he suffers from anxiety and depression. He has pain in the lower abdominal and the pain is worst in the morning. He sleeps interrupted due to the parenteral nutrition and because his ostomy is being filled.
After another two weeks he feels nausea and he is vomiting. He has a hard time taking his painkillers. His wife feels insecure with the situation and he is admitted.
He dies after a week at the hospital.
Could the patient’s course of illness have been different? Better? How? Could the readmission have been avoided? How?