Wednesday, November 24, 2010

Palliative Vs. Hospice Care

We had a discussion at our training meeting. Currently anticipating the opening of a Day Hospice in Perth, Jan. 17, 2010, we have been examining the concept and the philosophy.

In my mind Palliative Care is when one is designated as receiving comfort measures. Long-term treatment is discontinued. Physicians declare a patient palliative, and this entitles the patient to particular services. It is a change in focus from treatment to care measures.

Hospice care, I believe to be a philosophy of a delivery of services, either at home or in a building or institution, to ensure that the dying ensure that their appropriate medical, spiritual, social needs are being met.

This differs in the US, of course, as a physician must declare a patient palliative before they qualify for certain relief measures, both physical and financial.
In Canada, the terms are interchangeable, as we have universal health care, nor matter our diagnosis.

The Hospice movement, begun by Dame Cicely Saunders (1918 - 2005), established the first Hospice, in the UK, in 1967. As with many movements, it took time to be accepted by the medical establishment.
Josephine, myself, 5-hour old Isabelle

Midwives and home care
I recall midwives fighting for recognition and hospital privileges 30+ years ago when my first child was born. In this generation, they are part of an OHIP-funded program in which expectant mothers are visited, given training, and they may choose to have their children in hospital, in comfortable birthing centres, or in their homes, as my daughter did this year (2010), 6 months ago.

I  credit these well-trained women, who visit pregnant women daily both pre- and postpartum. They appear when needed at any time of day or night, and teach mothers about breast-feeding, prevent jaundice, give support in sleep hygiene, ensuring that they thrive. In normal births provide an incredible system of care, much like the goals of the Family Health Teams in Ontario.

From Pediatrics to Geriatrics
I have noticed that as great progress has been made in pediatrics, we make progress in geriatrics. We are realizing the importance, as well as the dearth, of geriatricians. For those facing health issues in later ages, geriatricians realize that theirs is complex care. By the time a senior is facing palliative care, the medical establishment needs specific training. While the physician is trained to heal, they are not trained to deal well with death and dying. This is where Hospice, and experienced physicians, can meet in dealing with end-of-life care.

No Hospice support here
It was Dr. Balfour M. Mount, O.C., Q.C., brought palliative care to North America. He began a study in Montreal's Royal Victoria Hospital, which led to the introduction of Elisabeth Kubler-Ross work being

Importance of Palliative Nurses

It requires much nursing care, experience in treating pain, and comfort measures designed to ease the passing of clients and residents. The physical breakdown of the skin requires tremendous intervention in many situations. It is our precious nursing staff who can turn a client frequently.

Communication Book for Mom's Hospice Care
The difference between healing and hurting may be a fine line. Further treatment may be contraindicated. This is difficult for physicians to accept. My father, for example, had radiation therapy when the predictable outcome was pretty bleak. His quality of life was destroyed. His brain tumour, as the research shows, was not going to be diminished by radiation and the ensuing urinary infection led to both dementia, from the tumour, and delirium, from the infection.

Again, much like a natural home birth, a hospice death is one infused with dignity, comfort and supportive caregiving from family, volunteers or professional caregivers. It is not limited to these people. Primary Care Staff (physicians familiar with palliative care measures, nurses who are similarly trained) are an important as medical decisions are made. There must be a realistic understanding and creation of a treatment plan, or a care plan, in the case of a palliative situation. I implore you to seek advice from a hospice organization near you.


Sandra said...

Very informative post. Both teams provide care that focuses on patient comfort. However, hospice care is generally suggested by a physician after all options for treatment have been tried and found to not be useful.

Jenn Jilks said...

I found, Sandra, that physicians are terribly reluctant to declare a client palliative. It is up to the patient to determine when treatment stops.
Hospice teams in Canada tend to be volunteers, with support coming partially from government funding. Whether a patient is palliative or not, in Ontario patients go through CCAC to get home care.