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Palliative care 

Palliative care

Palliative care

Bee Wee


May 30, 2013: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 28 April 2017

Palliative care addresses the physical, psychological, social, and spiritual needs of someone with advanced, progressive, and fatal disease. Good symptom control requires meticulous assessment, effective two-way communication, and the wise use of drugs, supported by other therapeutic interventions.

Common symptoms are (1) pain—one of the most feared symptoms in patients with advanced malignant disease; managed with disease modifying treatments, nondrug measures (e.g. heat pads), and/or analgesics (see also Chapter 30.1); (2) nausea and/or vomiting—after exclusion/treatment of reversible causes, management is with antiemetics chosen to target the receptors likely to be involved in the particular case and delivered by an appropriate route (oral or nonoral); (3) breathlessness—a disabling symptom in many patients with chronic and progressive illnesses; management requires dealing with reversible causes (e.g. anaemia, chest infection), nondrug measures (e.g. relaxation techniques, fans), and/or drugs (e.g. strong opioids); (4) constipation—an under-recognized problem which must be handled proactively with rectal measures and/or oral laxatives; (5) depression—which is common but often not perceived; diagnosis and early treatment with antidepressants and psychological support are usually effective; (6) anorexia and fatigue—these are the ‘Cinderellas’ of symptom control, less amenable to drug therapy but requiring the management of the distress and frustration of the patient and family.

Medical emergencies are relatively uncommon in palliative care, but prompt diagnosis and (when appropriate) intervention are essential. However, it is vital to diagnose dying to avoid unrealistic attempts to cure or prolong life in hopeless situations. Once death is seen to be inevitable and imminent, the focus of care should change from sustaining life at all costs to supporting the natural process of dying.

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