INTRODUCTION TO PALLIATIVE CARE

Alison HumphreyClinical Nurse Specialist in Palliative Care, STH

AIMS To explore development of Palliative Care

Definitions

Where are we now

Service available and how to access them

HISTORY OF HOSPICE/PALLIATIVE CARE

HISTORY OF HOSPICE Existed in Roman Times – Charitable institutions for travellers19th century religious influence and opened for care of the dying

MODERN HOSPICE CAREInfluenced by Ciceley SaundersSeparation 1945-1965Transition 1965-1985Incorporation 1985 - present

PALLIATIVE CARE

SUPPORTIVE CARE

END OF LIFE CARE

PALLIATIVE CARE

PALLIATIVE CARE

SUPPORTIVECARE

END OF LIFE CARE

PALLIATIVE CARE

‘Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems physical, psychosocial and spiritual’ (WHO, 2002)

Palliative Care should involve holistic care according to NICE (2004) striving for ‘best quality of life’, ‘applicable earlier in the course of the illness in conjunction with other treatments’ and ‘to help patients to live as actively as possible until death and to help the family to cope during the patient’s illness and in their own bereavement’ (p.20).

SUPPORTIVE CARE The emphasis of supportive care is to support patients

and families ‘during treatment and allowing them to live as well as possible with the effects of the disease’ (NICE, 2004 p.18) and even mentions from diagnosis through to cure as well as to death and bereavement.

This would fit with the cancer survivorship, initiative (DOH, 2007a, 2010); a cancer survivor being : ‘someone who has completed initial treatment and has no apparent evidence of active disease, or is living with progressive disease and may be receiving treatment but is not in the terminal phase of illness, or someone who has had cancer in the past’ (Corner, 2007).

Long Term Conditions

END OF LIFE CARE

End of Life Care Strategy (2008) has the aim of allowing patients to ‘live as well until they die throughout the last phase of life and into bereavement’.

The last phase considered to be last 12 months of life. Advanced Care Planning Amber Bundles

EMPHASIS ON END OF LIFE CARE

One in 10 patients die during their hospital stay Chris Smyth The Times Published: 19 March 2014 Liverpool care pathway review shows challenges in

palliative care Melanie Henwood Guardian Professional, Tuesday 23 July 2013 

Neuberger Report, 2013 Francis Report, 2013

GENERAL PALLIATIVE CARE

‘General palliative care is the level of palliative care which should be provided by all healthcare professionals, in primary or secondary care, within their duties to patients with life-limiting disease’

SPECIALIST PALLIATIVE CAREHolistic and multidisciplinary approach

MDT consist of Doctors, Nurses, Social Worker, Therapists, Chaplain, Complementary Therapies

Provided at the expert level, by a trained, multi-professional team in order to manage persisting, sever or complex problems

UUncontrolledComplex

Symptoms

PsychologicalEmotional

IssuesRelated to

illness

Complex Social Issues

PsychospiritualIssues

REFERRAL CRITERIA

End of Life care

REFERRALS NOT MEETING CRITERIA

Condition inactive

and stable

Long term care

Palliative Package of

care

Respite

Chronic

Pain

SERVICES AVAILABLE IN STHHospital Support Team consisting of Consultant, Registrar and Clinical Nurse Specialists

Macmillan Palliative Care Unit – 18 bedded inpatient unit

Outpatient clinics run by Consultants and RegistrarsCommunity Visits

Complex Case Management

COMMUNITY TEAM SERVICES IN SHEFFIELD

Community Specialist Palliative Care Team consisting mainly of Clinical Nurse Specialists with access to Consultant and Registrar Support

St Luke’s Hospice Inpatient Centre – 20 bedded unit

Therapies and Rehabilitation Centre – Day Care

OUT OF HOURS

Community – Contact St Luke’s main switchboard.

STH Palliative Care CNS Team providing seven day, 9-5 service

STH after 5pm – Contact switchboard who will contact Registrar on call for Palliative Care

HOW TO REFER

Complete referral form with as much detail as possible and urgency

Fax to appropriate number

Send additional information if felt needed

REFERRAL FORM

REFERRAL FORM

HOW REFERRAL IS PROCESSED FOR COMMUNITY SERVICES AND INPATIENT UNIT

Discussion at Daily Referral Meeting

If accepted, allocated to

requested serviceContact

made with patient

If not accepted, reasons given

Referring Professional contacted

REFERRAL TO HOSPITAL SUPPORT TEAM

Referrals reviewed by Palliative Care CNS

Referrals prioritised

Visit ward

REFERENCESCORNER, Jessica (2007) Making the National Cancer Survivorship Initiative a Reality

powerpoint presentation at Britain against Cancer Conference London http://www.macmillan.org.uk/Documents/GetInvolved/Campaigns/Campaigns/APPG/brita accessed

DEPARTMENT OF HEALTH, MACMILLAN CANCER SUPORT AND NHS IMPROVEMENT (2010) National Cancer Survivorship Initiative (NCSI) Vision. London, Crown

DEPARTMENT OF HEALTH (2008) End of Life Care Strategy - Promoting high quality care for all adults at the end of life. London, Crown

DEPARTMENT OF HEALTH (2013) MORE CARE,LESS PATHWAY A REVIEW OF THE LIVERPOOL CARE PATHWAY

NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (2004) Improving Supportive and Palliative Care for Adults with Cancer London, National Institute for Clinical Excellence

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry www.midstaffspublicinquiry.com

The AMBER Care Bundle Design Team (2011) www.ambercarebundle.orgWORLD HEALTH ORGANISATION (2002) WHO Definition of Palliative Care h

ttp://www.who.int/cancer/palliative/definition/en/