Palliative Care in the Acute Care Surgery Setting
Palliative care is medical care focused on symptom reduction and improvement of quality of life for patients with serious, life-threatening, or debilitating illness. Acute care surgical patients who will benefit from palliative care include those common s
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Bridget N. Fahy
Palliative Care Defined Palliative care is based upon the Latin word palliare, to cloak. Based upon this Latin root, it follows that palliative care is focused on providing cover or protection to patients. In its purest sense, palliative care is intended to shield or protect patients from suffering. According to the current World Health Organization (WHO) definition [1], palliative care is “an approach that improves 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.” Furthermore, the following are considered essential elements of palliative care services: • Provides relief from pain and other distressing symptoms • Will enhance quality of life and may also positively influence the course of illness • Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life • Includes those investigations needed to better understand and manage distressing clinical complications • Integrates the psychological and spiritual aspects of patient care
B.N. Fahy (*) Division of Surgical Oncology, Department of Surgery, University of New Mexico, Albuquerque, NM, USA e-mail: [email protected]
• Offers a support system to help patients live as actively as possible until death • Affirms life and regards dying as a normal process • Intends neither to hasten or to postpone death • Offers a support system to help the family cope during the patient’s illness and in their own bereavement • Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated Based upon this definition and the associated key elements, palliative care is ideally suited to the care of the acute care surgical patient given its focus on pain and other distressing symptoms, its holistic approach to the patient and their family, the emphasis on a team approach to both the patient and his/her family, and its applicability in conjunction with other therapies intended to prolong life. Notably absent from the WHO definition provided above is a proscription about who can provide palliative care or what specific interventions or treatments may be considered palliative. The definition above leaves open a role for all healthcare providers to utilize any and all tools available which will meet the needs of their patients and families as they face serious, life-threatening, and/or debilitating illness. An important corollary to the essential components of palliative care is an understanding of what palliative care is not. Perhaps most importantly, palliative care is not synonymous with hospice care. Hospice is a program of services designed to provide care to patients and families when a patient’s life expectancy is six months or less. In contrast, palliative care is appropriate for patients with potentially cura
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