The Importance of Early Referral to Palliative Care

Instructions for assignment
Discuss :
importance of early referral to palliative care (600)
Role of radiotherapy in palliative care (600)
The advantages and issues associated with early referral to palliative care (600)

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152720/
https://www.nice.org.uk/guidance/ng142/evidence/b-timing-of-referral-to-palliative-care-services-pdf-6955526991
https://www.um.edu.mt/library/oar/bitstream/123456789/862/1/2007.Vol19.Issue4.A1.pdf
https://www-pub.iaea.org/MTCD/Publications/PDF/Pub1388_web.pdf
https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-019-0415-8
https://www.mdpi.com/2227-9032/8/1/36/htm
https://www.pdfdrive.com/evidence-based-practice-of-palliative-medicine-expert-consult-online-and-print-1e-d176094017.html
file:///C:/Users/Windows%20-%20User/Downloads/Evidence-Based%20Practice%20of%20Palliative%20Medicine_%20Expert%20Consult_%20Online%20and%20Print,%201e%20(%20PDFDrive.com%20).pdf
https://www.redjournal.org/article/S0360-3016(18)33408-4/fulltext

 

Sample Answer

 

Palliative Care

Importance of Early Referral to Palliative Care

Palliative care refers to specialized care given to persons with complex, chronic, or severe illness. The goal of palliative care is to improve the quality of life of the patient and to relieve or manage the stress and symptoms associated with that illness. The first importance of early referral to palliative care is that it provides an opportunity to address the patient’s condition before it progresses to a higher level of severity (NICE, 2019). The early referral ensures that the palliative care interdisciplinary team has an opportunity to address the symptoms and pain of the patient at the early stages (Colwell, 2014). As such, early referral ensures that the patient can receive high-quality care which will minimize the possibility of the pain and symptoms progressing to the extent that causes severe pain to the patient and limits their life. And stress to both the patient and their family. As such, early referral to palliative care helps to prevent a medical crisis.

Secondly, early referral to palliative care contributes to improvements in the quality of care provided to the patient. Early referral to palliative care presents an opportunity for the palliative care team to undertake a comprehensive assessment of the patient’s situation at the initial or early stages of the illness or condition (Hui et al., 2014). Such information will allow the palliative team to develop a care plan that will be effective in the management of the illness. Early referral allows the patient to develop lasting and trustful relationships with the palliative care team. Such relationships improve the quality of care by allowing the team to develop a greater understanding of the patient’s condition in order to design a plan of care that is centered on the specific needs of that patient. Early referral also improves the quality of care by allowing the patient and their families to participate in developing the plan of care in the early stages of the progression of the patient’s illness (Devi, 2011). The participatory nature of the planning and decision-making ensures that the patient receives quality care early enough to improve their condition, minimize stress, and ensure longer survival.

Early referral allows the patient, as well as their family, to access timely psychological services (Barton, 2014). Since the patients and their families have to grapple with the psychological and emotional burden that comes with living and managing a serious medical condition, there is a need for psychological services such as therapy in the early stages of the illness. Early access to palliative care and the psychological services allows the patient to get used to the new reality of the illness, thereby improving their ability to adjust mentally and emotionally to the palliative care (Devi, 2011). The psychological services contribute to improvements in care and the patient’s condition by addressing the patient’s anxieties and mitigating the stress and depression associated with chronic and severe illness.

Early referral to palliative care is important because it leads to a considerable reduction in the number of hospital admissions, ICU admissions, and emergency department visits for the patients (Barton, 2014). Early referral allows the palliative care team to provide quality care that improves the patient’s condition and allows for better management of the symptoms and pain. The improvements from early referral to palliative care minimize the chances of severe incidents, which leads to a reduction in emergency department visits. Early referral to palliative care has a positive impact on the health status of the patient (Hui et al., 2014). As such, the patient is less likely to have a deterioration of condition to a point where they require ICU admission. Consequently, early referral to palliative care can significantly reduce, or even completely eliminate, hospitalization for the patient.

 

 

Role of Radiotherapy in Palliative Care

Radiotherapy is a form of treatment that utilizes high doses of radiation such as x-rays to treat cancer, tumors, and other conditions. In palliative care, radiotherapy is useful because it allows patients to find relief from the pain of their condition. Radiotherapy is especially recommended as an approach to relieve and manage bone pain.  One of the most critical problems that cancer patients have to deal with is bone metastases (Golstein & Morrison, 2013). A bone metastasis develops following the spread of cancer cells to the bone from their original site. Any type of cancer has the potential of causing metastases in the bones. Research indicates that around 70% of people with advanced cancer develop bone metastases (Spencer et al., 2018). Bone metastases cause pain to the cancer patient and can also lead to broken bones. The pain from the bone metastases can be intermittent or constant but the severity increases as the cancer progresses. Furthermore, bone metastases can hamper the ability of the patient to engage in physical activity. One of the most effective ways to combat the bone metastases is through radiotherapy. The radiation therapy treats the bone spurs and allows relief to the bone pain. As such, radiotherapy plays a crucial role in relieving the pain of cancer patients in palliative care.

The second role of radiotherapy in palliative care is to treat symptoms of cancer in the brain. Brain metastases develop in cancer patients when the cancer cells migrate from their original location to the brain. Studies indicate that between 20% and 40% of patients with cancer develop brain metastases (Spencer et al., 2018). The brain metastases will change the structure and function of the brain tissue. The symptoms of the brain metastases include mental problems such as memory loss, seizures, alteration in consciousness, and frequent headaches. Without treatment, the symptoms of the brain metastases progress in severity. Consequently, patients in palliative care require radiotherapy to treat the brain metastases and find relief from the associated symptoms (Gaspar et al., 2019).

The next role of radiotherapy in palliative care is to shrink tumors with the goal of relieving pressure or blockages in the body. Cancer can have the effect of blocking some passages around the body such as the trachea or oesophagus. The cancer can also put pressure on the nerves or organs. The pressure and blockages can cause pain or discomfort to the palliative care patient. For instance, blockage of the trachea can cause the patient to have breathing difficulties. Pressure on the nerves and organs such as the liver or the stomach can cause the patient pain. In the absence of treatment, the blockages and pressure can be extremely painful for the patient (Goldstein & Morrison, 2013). Palliative radiotherapy helps to treat the blockages and pressure thus relieving the palliative care patient from pain.

Radiotherapy in palliative care is useful in treating the spinal cord compression. When a cancer grows in the tissues around the spine, complications related to spinal cord compression can emerge. The compression happens due to the pressure of the cancer on the spinal cord. The spinal accord compression causes back and neck pain which gets severe as the cancer progresses (MacDonald et al., 2019). The patient will also experience difficulty walking or engaging in physical activity, leg weakness, bowel problems, and incontinence. Radiotherapy is the most effective way to treat spinal cord compression and relieve the patient from the pain of the complication.

Advantages and Issues Associated with Early Referral to Palliative Care

The first advantage of early referral to palliative care is that it allows for early decision-making regarding the care of the patient. Early referral to palliative care allows for advance care planning for the patient with the chronic or severe illness. In advance care planning, the patient and their families, in collaboration with health care professionals, have an opportunity to make decisions about the care of the patient in case a medical crisis emerges (Kuusisto et al., 2020). Ealey referral to palliative care is advantageous because the patient will have an opportunity to plan for their care in advance when suffering from a life-limiting illness or in case they experience a medical emergency that inhibits their decision-making. As such, early referral to palliative care allows the patient to make decisions about their health and care.

Early referral to palliative care is beneficial because it helps to reduce or manage the symptom burden of the patient’s illness or condition. Patients in palliative care live with life-limiting conditions and illnesses that are also associated with pain and discomfort (Barton, 2014). Therefore, early referral to palliative care provides an opportunity to initiate care that is purposely intended to manage the symptoms and provide relief to the patient. As such, early referral to palliative care improves the capacity of the interdisciplinary teams to manage the symptoms of the illness. Evidence shows that patients who are referred late to palliative care face a higher symptom burden than patients who have an early referral. Therefore, early referral to palliative care is beneficial in managing the symptoms of the patient’s illness.

Another advantage of early referral to palliative care is that it improves the patients’ quality of life (Thaniyath, 2019). Early referral allows the palliative care team to identify problems in the early stages. The team then takes steps to manage or mitigate those problems to improve the patient’s condition thereby improving their quality of life. Early referral to palliative care improves the patient’s quality of life by enabling access to a range of services that will provide mental and emotional reprieve from the stress, depression, sadness, and anxiety of dealing with the situation. Such services include counseling, therapy, and support groups which allow the patient to overcome the emotional and psychological burden of their condition thus improving their quality of life.

The first issue associated with early referral to applicative care relates to the formulation of a prognosis. The prognosis provides information on the progress of the patient’s condition. The prognosis guides the recommendation for early referral to palliative care. However, using the short-term or medium-term prognosis as the principal tool to guide decisions on early referral to palliative care can present a challenge since because the prognosis can be inadequate (Romano, 2020). Therefore, the prognosis can have a considerable influence on the decision to refer the patient to palliative care.

The next issue associated with palliative care is the physician’s recommendation. The decision to send a patient to palliative care is normally made by the physician overseeing the treatment of that patient. In some instances, the physician may hold the view that the treatment the patient is receiving is sufficient and that palliative care is not meaningful in the case of that patient (Vanbutsele et al., 2019). In such a situation, the physician is less likely to refer the patient to palliative care in the early stages. Another issue associated with palliative care is the patient’s decision and autonomy regarding their treatment and care. In some instances, the patient or their family may decline an early referral from their physician to palliative care. In such a situation, health care professionals have to respect the patient’s decision to decline the early referral to palliative care.

 

 

References

Barton, M. K. (2014). Early outpatient referral to palliative care services improves end‐of‐life care. CA: a cancer journal for clinicians64(4), 223-224.

Colwell, J. (2014). Early Palliative Care Referrals Better for Cancer Patients. Cancer Network Retrieved from: https://www.cancernetwork.com/view/early-palliative-care-referrals-better-cancer-patients

Devi, P. S. (2011). A timely referral to palliative care team improves quality of life. Indian Journal of Palliative Care17(Suppl), S14.

Gaspar, L. E., Prabhu, R. S., Hdeib, A., McCracken, D. J., Lasker, G. F., McDermott, M. W., … & Olson, J. J. (2019). Congress of neurological surgeons systematic review and evidence-based guidelines on the role of whole brain radiation therapy in adults with newly diagnosed metastatic brain tumors. Neurosurgery.

Goldstein, N. & Morrison, S. (2013). Evidence-based practice: Palliative care. Philadelphia, PA: Elsevier.

Hui, D., Kim, S. H., Roquemore, J., Dev, R., Chisholm, G., & Bruera, E. (2014). Impact of timing and setting of palliative care referral on quality of end‐of‐life care in cancer patients. Cancer120(11), 1743-1749.

Kuusisto, A., Santavirta, J., Saranto, K., Korhonen, P., & Haavisto, E. (2020). Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective. Journal of Clinical Nursing.

Macdonald, A. G., Lynch, D., Garbett, I., & Nazeer, N. (2019). Malignant spinal cord compression. JR Coll Physicians Edinb49(2), 151-156.

NICE, 2019. End of life care for adults: service delivery. National Institute for Health and Care Excellence. Retrieved from: https://www.nice.org.uk/guidance/ng142/evidence/b-timing-of-referral-to-palliative-care-services-pdf-6955526991

Romanò, M. (2020, March). Barriers to Early Utilization of Palliative Care in Heart Failure: A Narrative Review. In Healthcare (Vol. 8, No. 1, p. 36). Multidisciplinary Digital Publishing Institute.

Spencer, K., Parrish, R., Barton, R., & Henry, A. (2018). Palliative radiotherapy. Bmj360.

Thaniyath, T. (2019). The Quality of Life of the Patients Under Palliative Care: The Features of Appropriate Assessment Tools and the Impact of Early Integration of Palliative Care. IntechOpen.

Vanbutsele, G., Deliens, L., Cocquyt, V., Cohen, J., Pardon, K., & Chambaere, K. (2019). Use and timing of referral to specialized palliative care services for people with cancer: A mortality follow-back study among treating physicians in Belgium. Plos one14(1), e0210056.

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