The hosts discuss the challenges of end-of-life care, including limited scope of practice and lack of education. They explore the importance of lasting power of attorney and advanced decision to refuse treatment forms. The speakers also highlight the role of language and accessing support in this type of care. They delve into the management of symptoms and approach to terminal hemorrhage. Overall, the podcast provides valuable insights on delivering excellent end-of-life care in the emergency care setting.
Accessing support from hospices and collaborating with GPs can enhance palliative care in the community.
Holistic palliative care involves addressing physical, psychological, social, and spiritual aspects, requiring a multidisciplinary team.
Effective communication, initiating conversations using phrases like 'I wish, I worry, I wonder,' and involving families in decision-making are crucial in palliative care.
Deep dives
Accessing support and guidance in the community
For pre-hospital clinicians, accessing support in the community for palliative care patients can include contacting hospices for advice through their 24/7 helpline. They can provide expert advice and sometimes even direct patients to the hospice. GPs also play a vital role in palliative care, but they are often stretched. Collaborating with GPs and involving them in discussions and decision-making can be beneficial. Paramedics and community emergency medicine services, where available, can also help in providing support and guidance in the community.
Pillars of holistic care
Holistic palliative care includes addressing the physical, psychological, social, and spiritual aspects of a patient's life. It is essential to recognize that dying is not just a medical event but the culmination of a person's entire life. Multidisciplinary teams, involving professionals like physiotherapists, occupational therapists, chaplains, and social workers, can provide comprehensive care to patients and their families.
Communication and shared decision-making
Effective communication is crucial in palliative care. A supportive and empathetic approach, building a human connection with patients and their families, is more important than having a specific set of phrases or frameworks. Openly discussing wishes, fears, and goals, using phrases like 'I wish, I worry, I wonder,' can help initiate conversations and guide decision-making. Involving families in these discussions, preferably through well-facilitated family meetings, can ensure shared decision-making and a better understanding of the patient's wishes.
Patient preferences and care settings
Patient preferences for end-of-life care can vary widely, and it is crucial to individualize care accordingly. While some patients may prefer to die at home surrounded by loved ones, others may require different settings due to factors like abusive relationships or inadequate resources at home. The focus should be on living well until the end of life, rather than simply achieving a 'good death.' Recognition of trade-offs and involving the patients in decision-making about their care priorities becomes essential. Hospital admission for end-of-life care is not a failure in itself, as long as it aligns with the patient's wishes and needs.
Managing end-of-life care: A holistic approach
The podcast episode discusses the importance of a holistic approach to managing end-of-life care, covering various aspects such as equipment, caregiving, medications, and advanced care plans. The speaker emphasizes the need for appropriate equipment, including hospital beds and chemodes, to ensure the comfort and dignity of the patient. They also highlight the importance of determining who will provide the necessary care, whether it's loved ones or a care agency. The discussion emphasizes the need to ensure that patients have the right medications to alleviate pain and discomfort throughout their final days. Lastly, the podcast stresses the significance of advanced care plans that go beyond simply avoiding hospitalization, providing detailed instructions for managing symptoms and enabling patients to stay at home if desired.
Addressing specific symptoms in end-of-life care
This segment of the podcast explores the management of specific symptoms in end-of-life care. The discussion focuses on pain, breathlessness, nausea and vomiting, and anxiety. For pain relief, opioids are recommended and should be readily available in a patient's home. Breathlessness can be managed through various techniques, including positioning, breathing exercises, and handheld fans. Nausea and vomiting are approached by identifying the underlying cause and targeting anti-emetics accordingly. Lastly, anxiety and agitation can be addressed with medications such as levomepromazine and midazolam, aiming to provide tranquility and relieve distress. The episode acknowledges the complexity of these symptoms and underscores the individualized approach required to optimize end-of-life care.
Delivering excellent End of Life Care in the Emergency Care is a real challenge but also a huge privilege and has formed some of the most rewarding parts of our careers to date.
We've been really keen to End of Life Care as a topic for a while now. Many, if not all of you, will have been out to these patients or received them in your ED.
They aren’t simple cases to manage, with lots of issues around scope of practice, lack of alternative care pathways, confusion surrounding legal documentation and many studies have identified a lack of education around palliative care.
In this episode we’ll do our best to demystify those medico-legal terms, talk about care pathways and options that may be available to us, have a think about how we can talk with patients about death and then go on to discuss the clinical care we might need to deliver and the wider holistic nature of caring for these patients and their loved ones.
We're lucky enough to be joined by Ed Presswood, who's a palliative care consultant and clearly an expert on the topic. We gained a massive amount from this episode and we hope you find it really useful too.
You'll find the hyperlinks to some fantastic resources on the topic over on the webpage at TheResusRoom.
Once again we'd love to hear any comments or questions either via the website or social media.
Enjoy!
Simon, Rob & James
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