End of Life Care
End of Life Care
I. End-of-life care defined
Since the early periods of our civilization, it has been the duty of health care professionals and health care providers to contribute in the improvement of our society’s way of life. Central in this role is the maintenance and restoration of health with the treatment and prevention of diseases over time. However, the role of health care professionals and providers are not only limited on the exertion of efforts leading towards the restoration of a patient’s health. Nurses, doctors and other allied health professionals are also tasked with the provision of care to patients who are in the final hours or even moments of their lives which also includes patients in need of care for terminal illnesses and medical conditions that has already advanced into progressive and incurable stages. The form of care provided in this category is referred to as end-of-life care or EoLC.
While the use of end-of-life care or EoLC has been broadly mentioned in nursing and health care literature, Izumi, Nagae, Sakurai, and Imamura (2012) argued that there is still no existing consensus identifying the entering of a particular patient on the phase of end of life. They noted that the provision of end-of-life care may be identified based on regulatory, administrative or policy guidelines but there is still no sufficient scientific evidence pointing into the clinical indications of the period of end of life. In lieu of this, the National Institutes of Health (2004) have instead relied on the existence of two components in order to determine the necessity of administering an end-of-life care which include the existence of persisting chronic illnesses and other forms of functional impairments, and the presence of symptoms or disabilities drawn from diseases diagnosed by medical health professionals as irreversible and may soon lead to the patient’s death.
However, Izumi, Nagae, Sakurai and Imamura (2012) contested the ethical grounding and the vagueness of the National Institutes of Health consensus by saying that basing the delivery of end-of-life care on patients with chronic diseases and irreversible illnesses is still insufficient in identifying the need of a patient for an end-of-life care. As an example, the authors presented the case of a healthy older adult who may not have any significant life-threatening illness but is expressing and acknowledging his or her need for end-of-life care due to advanced age. In order to fill in this gap, they suggested that the determination of an individual’s need for end-of-life care should not only be based on the medical perspective of the existence of terminal illnesses but also “from the nursing perspective based on a broader view of life and journey toward the inevitable end of life” (p.614). In line with this, the researchers proposed to define end-of-life care as assisting “persons who are facing imminent or distant death to have best quality of life possible till the end of their life regardless of their medical diagnosis, health conditions, or ages” (p.616).
II. Provision of end-of-life care
Prior to the provision of end-of-life care, the United Kingdom National Health Service (2015) noted that the patient’s or their family’s right to self-determination should still remain intact in providing care. It is highly necessary to consult the patient or their family if the patient is incapable of deciding, on the manner by which the health care should be administered. These include making critical decisions as to where the patient would want to receive healthcare, the type and form of healthcare and other needs and preferences of the patient or his family. Among these considerations is the option of whether to undergo the patient in either palliative or hospice care.
Meier (2011) drew the distinction between palliative and hospice care. According to his study, palliative care is focused on the achievement of the best quality of life for the patient and his family regardless of the prognosis. Thus, palliative care could be administered as a primary, secondary or tertiary health care procedure. Even though it is ideally intended for patients with serious illnesses, it does not set aside the administering of other curative treatments and may in fact go together in the provision of an optimal medical care for the patient. Palliative care usually involves the maintenance and assurance of the patient’s comfort by managing pain, other symptoms, and other forms of support.
On the other hand, Meier (2011) noted that the hospice services particularly in the United States are bounded by the Medicare’s restriction only for patients with a definitive prognosis of living for at most six months. Though hospice services, in essence, still provide palliative care, the process is only reserved for patients who decided to forgo curative procedures and treatments in order to focus more on maximizing the patient’s comfort and quality of life within his prognosis of living. The decision to resolve into hospice services may be present when the conducting of curative treatments are no longer beneficial, when the burden of treatment already outweighs the benefits or if the patient is already approaching the last weeks or months of life. In addition to these the hospice supports the family all throughout the care process and even in the provision of bereavement services upon the patient’s death. In order to fully identify the distinctions between palliative care and hospice, the National Hospice and Palliative Care Organization (in National Institute on Aging, 2012) illustrated the distinctions in Table 1.
(National Institute on Aging, 2012)
III. Elements of Quality Palliative Care and Hospice
In the delivery of palliative care to patients, the National Consensus Project for Quality Palliative Care (2004) highlighted four key structural staff elements. These include (1) the presence of an interdisciplinary clinical staff ranging from physicians to counselors, (2) sufficient staff to patient ratio, (3) staff trained or experienced in palliative care, and (4) a certainty of accessibility and responsiveness 24/7. According to the National Institute on Aging (2012), the staff tasked with the provision and administration of palliative care is responsible on four key areas: physical comfort, emotional and mental needs, spiritual issues, and fulfillment of practical tasks. The availability of palliative and hospice care improves the quality not only of health care but also of the patient and the lightening up of the family burden as well. With this, the comfort of the patient is assured even at the last moments of his life.
References
Izumi, S., Nagae, H., Sakurai, C., & Imamura, E. (2012). Defining end-of-life care from perspectives of nursing ethics. Nursing Ethics, 19(5), 608-618.
Meier, D. E. (2011). Increased access to palliative care and hospice services: Opportunities to improve value in health care. Milbank Quarterly, 89(3), 343-380.
National Consensus Project for Quality Palliative Care. (2004). Clinical practice guidelines for quality palliative care. New York, NY.
National Health Service. (2015). End of life care. Retrieved March 5, 2016, from http://www.nhs.uk/Planners/end-of-life-care/Pages/what-it-involves-and-when-it-starts.aspx
National Institutes of Health. (2004). National Institutes of Health state-of-the-science conference on improving end-of-life care.
National Institute on Aging. (2012). End of life: Helping with comfort and care. Retrieved March
5, 2016 from https://d2cauhfh6h4x0p.cloudfront.net/s3fspublic/end_of_life_helping_ with_comfort_care_0.pdf?IGMC_QvI2QQxHoRWy4t7UVKWy3wfaCCa
