Cross Country Universitys Caregiver Safety Series

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End of Life Care

Palliative versus curative care

In healthcare, much of the focus is on curative care. This is as it should be. The goal is for patients to get better. The objectives of curative care are:

To obtain a cure

To return patients, as much as possible, to normal functioning.

Sometimes, these objectives cannot be met and the patient is considered terminally ill. The patient or family may have decided to discontinue curative treatment or there may be no curative treatment available.

The patient's care now becomes palliative. The objectives of palliative care are:

To make the patient as comfortable as possible

To support the family during this end-of-life period.

Importance of pain control

Pain control is an essential part of end-of-life care. Many cancer patients, for example, say that their biggest fear is having uncontrolled pain before they die. The challenge for healthcare professionals is to manage pain so that patients can focus on other end-of-life issues.

During this phase, it is important to reassure patients and families about your facility's commitment to pain control. Both pharmacological and non-pharmacological measures should be used to ease the patient's pain. Be sure to involve patients and families in deciding what methods work best to meet the individual needs of the patient.

You should also assure them that opioids can play an important role in controlling pain. Use of opioids to control pain will not cause addiction and can help the patient to:

Rest better

Be more mentally alert

Avoid depression.

Patients will have been asked about any advance directives when they were admitted. You should assure them that a "Living Will" or a "Do Not Resuscitate" order will not prevent them from receiving pain relief as a part of their care.

Patients who might be good candidates for hospice care may also need reassurance. Assure the patient and family that pain control is one of the main focuses of hospice care.

Sometimes, nursing staff are concerned about giving opioids as often as ordered because of fears about side effects. Remember that the objective of palliative care is to control pain and

keep the patient comfortable. Higher than usual doses may be required to control the pain effectively.

Pain relief is the priority for terminal patients.

Caring for the terminal patient When caring for the terminal patient, you should:

1. Anticipate pain needs and provide relief before the pain becomes severe

Cross Country Universitys Caregiver Safety Series

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Copyright, 2013, Cross Country University.

2. Remember that larger doses of analgesia may be needed because of tolerance to the drug and because of the progressive disease state

3. Assess the patient frequently for pain management needs 4. Discuss the pain management plan with the patient and family

5. Assure the family that everything possible is being done to keep the patient comfortable.

You may have to be creative in finding the best solutions for individual patients, but the family and patient provide a valuable source of help. LISTEN to your patient and his/her family.

As the disease progresses, the patient may no longer wish to eat or drink. Families find it hard to see their loved ones stop eating or drinking, and denial of what is happening is common and understandable. The family needs support during this time and help to understand the process.

End of End of Life Care Lesson