Demystifying Palliative Care: An Integral Part Of Healthcare Piece That Is Missing

“Palliative Care is armed with answers, you can provide patients and families with the information they need to make care decisions, yet it is always the last we resort too in care. We only go after palliative care when we have nothing else to do – a very sad situation it is” – Dr. Prince Appiah (Faculty Chair, Palliative Faculty, G.C.N.M).

As patient advocates, nurses are the link between health care providers, patients, and families in identifying the needs and addressing concerns about palliative care.

As patient advocates, nurses are the link between health care providers, patients, and families in identifying the needs and addressing concerns about palliative care.

What is palliative care?

W.H.O defines palliative care as an approach that improves the quality of life of patients and their families facing problems associated with a 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.

Objectives of palliative care

• Provides relief from pain and other distressing symptoms
• Affirms life and regards dying as a normal process.
• Intends neither to hasten nor postpone death.
• Integrates the psychological and spiritual aspects of patient care
• Offers support systems that help families 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.
• It enhances the quality of life and may positively influence the course of illness.

Palliative care vs Hospice care

The goal of palliative care is to improve the quality of life for individuals at any stage of serious illness, whether curable, chronic and life-limiting whereas Hospice care is a subset of palliative care that provides comfort at the end -of- life.

Palliative care can be provided alongside curative or life-threatening treatment while hospice care is provided when there is no cure in place. Thereby focusing on comfort care for the last 6months or less of life. Hospice care patients may no longer have therapeutic options or may have chosen not to continue treatment because side effects outweigh benefits.

The hospice care team provides care for the “whole person” including physical, emotional, social and spiritual

needs.

Palliative care family support and collaboration is paramount in deciding where care should be provided either in the home, hospital or hospice facilities.

Does a referral for palliative care mean the patient’s healthcare provider has given up hope for recovery

No, it should not be; palliative care strongly discourages its introduction only when provider has given up. The goal of palliative care is to help the patient has the best quality of life attainable.

Receiving palliative care whiles undergoing aggressive treatment for an illness can help patients cope with treatment-related side effects. Some researchers have show that it may extend a patient's lifespan although that it is not intention of palliative care. Sometimes, in the course of life-threatening situations, “HOPE” becomes less about the cure and more about living life as fully as possible.

Does palliative care hasten death?

Palliative care does not hasten death; it provides comfort and best quality of life from time of diagnosis until the end of life. It promotes a “good death” not a distressful death.

Who can receive palliative care?

Palliative care is for all patients, no matter their age, who have lost an identified quality of life. Hospice Care is for all patients no matter their age or sex who have terminal illness with poor prognosis with a life expectancy of 6 months or less.

Who provides palliative?

Many palliative care and hospice care teams are multi-disciplinary and includes Physicians, Nurses, Pharmacists, Chaplains, Social Workers, and Non- Professional Nurses, etc who are trained to provide this specialized care. In Ghana, Family Physician Specialists as part of their training go through palliative care specialists and they have the opportunity to have a fellowship program in Palliative Care.

The Ghana College of Nurses and Midwives is the sole agency mandated by law to train Specialist Nurses in Palliative Care and hence, Specialist Palliative Care Nurses only evolve out of this institution by law to provide Specialist Clinical Palliative Care Nursing.

Patients don't have to give up their primary providers; upon the introduction of palliative care, the care is a coordinated one which will include the patient's primary care team.

Other training institutions that are available to Africa include the Hospice Africa which trains palliative care initiators (PCIs) who can practice clinically in any African Country when certified by them.

There other programs from certificate to master's level that train people from different professional backgrounds in palliative care all the world, yet not all of them

are for clinical palliative practice.

Where can you have palliative care provided in Ghana?

At the moment formal palliative care services are only provided in the Korle- Bu Teaching Hospital- Family Medicine Department, the Komfo Anokye Teaching Hospital- Family

Medicine Department and the Tetteh Quarshie Memorial Hospital in Mampong.

Palliative care and hospice care however can be provided wherever the patient resides home, assisted living facility, long-term care facility, and hospital.

It does not require much equipment and space in setting up and it can be implemented in every hospital so far as the hospital has a palliative care practitioner trained to give clinical palliative care.

Does health insurance cover Palliative and Hospice Care?

The national health insurance does not cover palliative care in this country. There is a great need for the national health insurance and other private insurance companies and health maintenance organizations to offer palliative care and hospice benefits.

The way forward is policy; we pray and look forward every day to the time that the Palliative Care Policy will be passed by parliament to force the hand of the health provider into establishing palliative care as an integral part of primary health care.

It will indeed be a good chance in the delivery of healthcare in this country and the impact will be positive so far as the right personnel is deployed to do the actual clinical palliative care.

Providing answers

When a provider recommends palliative care or hospice care, patients and their families will need your support and guidance. When you're ready with answers to their questions, you help them understand the care they'll receive so they can make the best decisions possible.

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A Palliative advocacy Article by Mrs. Winifred Nana Yaa Otoo (MSN-FPN, BSN, DIP.GN, RGN), Mrs. Mercy Sarpong (BSN, DIP HE, RMN, SRN), Ms. Catherine Adoley Mensah (BSN, DIP GN, RGN), Ms. Lydia Asamoah (BSN, DIP. GN, RGN), Ms. Abigail Serwaah Boakye (BSN, DIP. GN, DIP. EDU, RGN) and Ms. Juliana Addai (BSN, DIP. GN, RGN); all residents of the Ghana College of Nurses and Midwives, Palliative Care Specialty Faculty, Nursing Division. May 2020 publication