• Affirms life.

• Views dying as a natural process.

• Neither speeds up nor postpones death.

• Relieves pain and other distressing symptoms.

• Integrates psychological and spiritual aspects of care.

• Provides support systems for patients to live as actively as possible until death.

• Offers support systems to help patients’ families cope during the patient’s illness and their own bereavement.

• Applies ethical considerations:

  • Do good

  • Do no harm

  • Respect patient’s right to decide

  • Fairness

Attributes of Palliative Care

Palliative care has distinct characteristics or attributes.

In palliative care, “attributes” are the features, traits, or qualities linked to or defining palliative care. These are the core elements shaping the nature and scope of palliative care as a specialized form of medical care.

Here are the key attributes of palliative care:

1. Holistic approach: Palliative care takes a comprehensive view, addressing:

   • Physical

   • Emotional

   • Psychological

   • Social

   • Spiritual needs of the patient.
     It sees the person as a whole, not just the disease.

2. Pain and symptom management: Palliative care aims to reduce pain, manage symptoms, and improve patient comfort. This includes:

   • Medications

   • Therapies

   • Other interventions to manage distressing symptoms.

3. Communication and coordination: Effective communication is vital in palliative care. The care team works closely with the patient and family to understand their:

   • Preferences

   • Goals

   • Values
     They also coordinate between healthcare professionals for seamless care delivery.

4. Patient-centered care: Palliative care respects patient autonomy and individual preferences. It involves shared decision-making, where patients are actively involved in choices about their care and treatment.

5. Family support: Palliative care recognizes the impact of serious illness on family members and caregivers. It provides:

   • Emotional support

   • Education

   • Guidance to help them cope with challenges.

6. Continuity of care: Palliative care is not limited to a specific location or time frame. It can be given alongside curative treatments and is often delivered at different stages of illness.

7. Advance care planning: Palliative care encourages patients to discuss and document preferences for medical treatment and end-of-life care in advance. This ensures their wishes are respected and followed.

8. Bereavement support: Palliative care extends support to the family even after the patient’s death. Bereavement services help family members cope with grief and loss.

9. Interdisciplinary care team: Palliative care involves a team of healthcare professionals with diverse specialties, including:

   • Doctors

   • Nurses

   • Social workers

   • Chaplains

   • Other specialists as needed.
     This team approach ensures comprehensive and well-coordinated care.

10. Dignity and respect: Palliative care emphasizes treating patients with respect, preserving their dignity, and providing compassionate care throughout their journey.

Essential Components of Palliative Care

Palliative care has two components:

• Pain and symptom control: Modern methods are used for:

  • Pain relief (including oral morphine for severe pain)

  • Symptom treatment

  • Symptom management

• Supportive care: The psychological, social, spiritual, and cultural needs of the patient and family, including bereavement care, are addressed.

Key Aspects to Palliative Care

• Focus on quality of life

• Holistic approach

• Multi-disciplinary team (MDT) – doctor, nurse, physiotherapist, occupational therapist, social worker

• Patient and family at the center of care

• Attention to details

• Availability of essential drugs, e.g., morphine

• Peace, comfort, and dignity of the patient and family.

Principles of Palliative Care

1. Patient-centered: Palliative care revolves around the patient and their family. It focuses on:

   • Maintaining hope with realistic goals

   • Supporting the patient and loved ones throughout different illness stages.

   • Sustaining hope with realistic goals to aid patients and families in coping appropriately through different illness phases.

2. Appropriate ethical consideration: There are many ethical issues in patient care. Principles include:

   • Seek to do good (beneficence)

   • Do no harm (non-maleficence)

   • Respect patients’ rights (autonomy)

   • Fairness (justice)
     Palliative care involves navigating various ethical dilemmas. Remember to balance doing what’s best for the patient while respecting their rights and autonomy.

3. Continuum of treatment: This involves ongoing management of pain and other symptoms, starting from diagnosis and extending beyond the patient’s passing. It includes:

   • Pain and symptom management

   • Bereavement care for the family after death (bereavement care).

4. Teamwork and partnership: Palliative care requires an interdisciplinary team to address the diverse needs of patients effectively. Addressing all patients’ needs alone is not feasible. An interdisciplinary team should be formed to handle all problems. No single profession can address all issues facing the patient. Team members share challenges facing the patient and plan effective management using their skill sets. A palliative care team includes:

   1. Nurses

   2. Doctors

   3. Social workers

   4. Religious leaders

   5. Teachers

   6. Community health providers > Others as appropriate.

5. Holistic care approach: Holistic care treats patients as whole persons, not just medical cases. This approach focuses not only on physical care, but also:

   • Psychological (emotional)

   • Social

   • Spiritual care.
     This psychological and emotional support should be available for:

   • Caregivers

   • Patients

   • Family members

   • Community volunteers

   • Professional care and support workers (health workers, counselors, social workers)
     Before, during, and after caregiving periods.

Holistic care: This is care of the whole person and is more than just drugs and physical care.

Components of holistic care

1. Physical care: This involves assessment and management of pain and other physical symptoms. It’s crucial because if physical symptoms are controlled, other aspects become easier to manage.

2. Communication care: Effective communication skills are key in holistic patient care. Providing:

   • Emotional support

   • Active listening

   • Compassionate understanding helps patients cope with emotional challenges.

3. Spiritual care: This is important for the terminally ill and includes:

   • Allowing patients to express their spirituality

   • Praying with them if requested

   • Arranging for a religious leader to visit if they request.

4. Family support: The terminal phase of illness is often very difficult for the patient’s family. Support is needed for the family, including:

   • Spending time

   • Listening

   • Giving support to them.

5. Social care: This incorporates discussion of social and family issues, e.g.:

   • Considering the well-being of young children who may become orphans

   • Discussing financial matters that can affect the patient and their family.

Models of Palliative Care

1. Health facilities based: Palliative care is provided in:

   • Hospitals (outpatient departments)

   • Other clinics designated by in-charge personnel.
     Health Centers IV and III with palliative care-trained health workers provide palliative care services using a facility palliative care team.

2. Health facility Out-reach programs: Specialist palliative care health workers travel to other centers to provide palliative care. In this model, palliative care is provided by palliative care-trained health workers. The team moves to the community to provide palliative care services closer to the people. Facility outreach programs are important as they bring services nearer to people, so patients don’t have to travel long distances and a mass of people can be seen within their villages.

3. Roadside clinics/stopovers: This is a care model that enables patients living far from health facilities to access palliative care. Health care providers plan with patients and caregivers to meet in identified places along routes or on their way to outreach areas. They make stopovers in agreed places, like trading centers, under trees, at particular signposts, or schools.

4. Facility Day Care:

This model schedules a specific day for patients and their caregivers to spend time with others at a facility (e.g., hospital, health center, hospice). Activities include:

• Recreation

• Socialization
  This helps patients share experiences and challenges, and provides opportunities to interact with and consult nurses or doctors on-site for their needs. They can enjoy meals together, fostering a sense of community and support.

5. Community Day Care:

Similar to facility day care, but it occurs within the patient’s community. Healthcare workers go to a designated community location (e.g., church, community hall, or someone’s home) to spend the day with patients.

6. Home Based Palliative Care Model:

This model delivers a complete care package to the patient and family within their home environment. This package covers:

• Spiritual

• Psychological

• Pain and symptom management

• Support with daily living activities.
  This care model is optimally delivered by a specialized palliative care team collaborating with trained community health volunteers.

Services Offered During Home Based Palliative Care:

• Basic physical care: Identifying symptoms, basic treatment, and symptom control.

• Essential nursing care: Assistance with:

  • Positioning and mobility

  • Bathing

  • Wound care and hygiene

  • Oral care

  • Medication management.

• Psychosocial support and counseling: Being present with the patient and family, offering comfort and understanding, active listening, and aiding the family in obtaining legal support. Providing resources like HIV testing, disclosure assistance, condoms, and safe water information.

• Spiritual support: Actively listening to patients and families’ spiritual concerns, anxieties, praying with them if requested, and preparing for death.

• Household assistance: Supporting patients with practical tasks such as:

  • Laundry

  • Cleaning

  • Shopping.

• Health promotion: Educating on disease prevention, including HIV and TB.

• Training for caregivers: Equipping them with fundamental nursing skills and care techniques.

Advantages and Disadvantages of Each Model