Identify issues in providing palliative care for people with both malignant and non malignant terminal illnesses. Identify a palliative care intervention and how it was experienced by the patient. Identify the concerns and requirements of the patient and their family.
Palliative care is a personalized medical assistance given to people with terminal or chronic illness. It is focused on providing relief to ailing patients. It provides sentimental care for improving the quality of life. Specially trained doctors, nurses, and other attandents treat the patients. These specialist works together to provide support to the patient and his/her family in times of great adversity. Symptoms of diseases, which include depression along with mood swings, pain in the body, nausea and headache, loss of appetite, difficulty in sleeping along with the terminal illness, cause much stress to the patient. To ease their pain it is necessary to provide them mental strength and treating them with empathy is necessary for their treatment. The palliative care team interacts and communicates with the patient to understand how to care for the patient with greater efficiency.
A patient, Mr. Banner age 65, suffering from prostate cancer symptoms he suffers each day are, need to urinate frequently at night, not able to control urine, interrupted flow, painful or burning sensation, blood in urine, pain in hips, thighs and lower back. Prostate cancer is a very slow developing disease. It starts with small changes in shape and size of the prostate gland, also called prostatic intraepithelial neoplasia (PIN). Causes of prostate cancer are many and varied they can depend on age, race, lifestyle, genetic makeup, other medications used like steroids, hormonal drugs, enhancement drugs and so on. Patients having BRAC2 gene have an aggressive form of prostate cancer. Diet of the patient is also responsible for developing cancer. Obesities and sexually transmitted diseases increase the instances of development of cancer. An enzyme produced in the body is also responsible for developing prostate cancer. PRSS3 is linked to the formation of aggressive cancer (Zimmermann et al. 2014).
The patient is treated with chemotherapy after a period of 17 months the cancer relapsed. The doctors performed Brachytherapy where radioactive seed is implanted into the prostate. The procedure failed other treatments were started like conformal radiotherapy- where radiation beams are shaped in such a way that they overlap and form the same shape as the organ or the region that needs treatment. This type of treatment reduces the healthy tissue exposure to the radiation (Zimmermann et al. 2014).
The expert doctors planned to use Intensity Modulated Radiotherapy when other treatment failed to curb the growth of cancerous tumors. The relapse of cancer caused the patient to undergo extensive painful treatment. The patient and his family were slowly losing hope. It was up to the palliative care provider to keep the morale of the patient and his family upbeat. Intensity modulated radiotherapy is performed by beams of variable intensity. This type of radiotherapy is an advanced version of the conformal radiotherapy, usually it is controlled by means of a computer. The computer-controlled linear accelerator controls the rate of intensity of the beam of radio waves. Treatment by this method is performed based on individual cases. In most cases when the cancer is in early stages the doctors, recommend then this type of treatment (Leidinger et al. 2016).
As the patient was suffering from an advanced type of cancer that had a tendency to reoccur, the doctors recommended Radial prostatectomy. However, the patient did not consent to the surgical removing of the prostate. Thus, the doctors had to find an alternative method of treatment. The doctors of the palliative care advised the patient and his family about the situation. They provided support and sympathy. As the patient was not consenting to removal of the prostate, the doctors recommended using a combination of radiotherapy and hormone therapy. The procedure for the radiotherapy requires treatment daily. This treatment can be ongoing for about eight weeks. Hormone therapy is a supportive therapy that helps in reducing the risk of the cancer spread or metastasis to other parts of the body. Hormone therapy is most effective during the advanced stage because it slows down and even stops in some cases, the growth of the cancer cells. During the first week of the combination therapy, all conditions were normal. In the second week the stats of the patient was stable. However, from the end of the third week the patient experienced some breathing problem due to inflammation of the neck and throat. The doctors after running some test concluded that the hormone therapy was causing an allergic reaction, which was causing the swelling. The doctors then tried it with a different hormone combination along with the radiotherapy. The results were the same, initially the patent responded adequately but then an allergic reaction was seen o develop. The doctors thought it would be safe for the patient to discontinue this way of treatment. They discussed this with the patient family, they gave their consent about discontinuing the treatment and find a better alternative (Leidinger et al. 2016).
The other option the doctors provided to the patient was to undergo clinical trials. The clinical trials conducted the expert team was a gamble that the patient family was willing to take, for the sake of the patent life. The clinical trials conducted by the expert team focused on each patient individually (japan 2016).
At the start of the clinical trials, the doctors performed blood tests to screen for any pathogen, virus or bacterial origin that may have had a hand in the reoccurrence of the cancer. After that, the doctors performed ultrasound of the lower abdomen to rule out any other parts of the body that may have been affected by the cancer. MRI scan was performed which revealed that the prostate glands were swollen and had tumors growth along its periphery. The doctors talked to the patient and his family about the options and the hypothesis on which they were working. Doctors also discussed the trial results obtained previously and compared the patient’s results with that of the cured patients. The doctors and the palliative team provided full cooperation to the patient so that he can make his decisions. They gave him information regarding various other treatments that are still available, but they were time consuming and if they did not work then the life of the patient will be at a risk. They gave him mental strength to overcome his fears and provided proof that there is life after the treatment of cancer. The patient Mr. Banner had full rights to express his concern about the procedures. The doctors encouraged him to lead a normal life even when the trials would be ongoing. The disease although dangerous and sometimes fatal but staying healthy and not getting worse was the key to survive cancer. The palliative team and the doctors worked day and night to assure Mr. Banner and his family that they are there to help him and give him all the necessary comfort and support needed to get him through these tough times. They explained to him that even though the condition is irreversible but they are trying their best to help him lead a comfortable and pain free life (Chow et al. 2015).
The initial assessment of Mr. Banner revealed that he has lost weight and abdominal pain in control, but the bladder control was lost and had a long way to recovery. The doctor put him through the clinical trial. Initially all the stats were seen to good and stable. The drug seems to work and was not causing any side effects. The kidney function test showed that they were functional at 70% capacity. Due to the advanced age of Mr. Banner 70 %, kidney function was considered normal. During the first week of treatment, the patient responded to the treatment, immuno-fluorescence technology. MRI scan showed that, at the end of the first week 20% cancerous cells were eliminated. The tumor size was seen to reduce a fraction. The reduction of tumor size continued until the end of the third week of the clinical trial. Mr. Banner’s condition was stable. The abdominal pain and the burning sensation were reducing. The doctors were hopeful about a good recovery. Although the bladder function had yet to return to normal. The doctors prescribed him sleep and rest as the accessory help to endure the highly toxic drug (Bükki et al. 2013).
The palliative team regularly communicated with Mr. Banner and his family about his recovery and the things that concerned the doctors. The doctors set up a team of specialists, which included Nephrologists, allergy specialist, a Cardiologist, a Pulmonologist, heading this team were the chief of clinical trials in that hospital. The palliative team informed the patient and his family about his progress each day. They answered any queries that were raised by the patient or his family. They educated his family about palliative care and what it entails. Palliative care was provided from the stage of diagnosis through the end of the treatment. It extends to the follow up Care and until the end of life. The palliative caregiver provides the patient information about the side effects and emotional problems faced by the cancer patients. The specialists work as a part of a multidisciplinary team, which consisted of doctors, nurses, researchers, dieticians, pharmacists. In some cases where the patient require external help then social workers join the team to help the patient to transition into his or her new life. Palliative caregiver may make recommendations and instructions regarding the future management of the patient. Normally people trust their primary physician than the palliative caregivers thus, it is more feasible for the patient to accept such advice (japan 2016).
The clinical trial of Mr. Banner continued, but on the end of the seventh week the health stat of the patient suddenly dropped, the sugar levels became high, the phosphate and the sodium levels dropped. The patient at the end of the week showed symptoms of sepsis. He was rushed to the ICU because the lungs had fluid in them, which was the cause for the sepsis. The patient went into coma. The doctors thought it was to his age and dormant infection in his lungs. The palliative team discussed their option and decided to continue the cancer treatment along with an antibiotic regime to counter the infection in the lungs. This expert decision in the end helped saved the life of Mr. Banner. The palliative team within the hospital was responsible for the good care of the patient and giving hope and encouragement to the patient family. They helped to put the patient and his family at ease. The patient started to recover from the coma. The response to the trial drug was again working. The patient recovery was a sign that the drug can be used for the treatment of prostate cancer. This encouraged the researchers to try and use the drug for further trials regarding other types of cancer like cervical cancer, blood cancer, pancreas cancer and other type of malignant tumors that ails half the population on earth (Bükki et al. 2013).
The social circumstances of Mr. Banner had changed since he came in the hospital for his treatment. Due to the prolonged treatment with toxic drugs, his immune system is very weak and he has been confined to a germ free, dust free room. His immediate environment has changed and to cope with these change social workers associated with the palliative team helped Mr. Banner to acclimatize with the changes that have been brought about after his extensive treatment. The social worker specialized in this field surveyed Mr. Banner’s home and provided his opinion on what changes have to be brought about to make the house as dust and germ free as possible. The nurses in the palliative team helped Mr. Banner to take care of his need when he returns home and gave him contact number if any emergencies arose. They also informed his general physician about the medications needed by Mr. Banner and let the GP now about his follow up appointments. Community palliative team was referred to Mr. Banner if the needs arose (Bill-Axelson et al. 2014).
Conclusion
In conclusion, it can be said that the palliative teams have members from all walks f life specializing in different things. They not only took care of the patient but also provided care and support to the family of the patient. They took care of the after treatment care at home. The performance of the palliative team was effective due to the efficient communication between the doctors and nurses and other specialists. The intervention of care was done successfully and good and working professional relationship was established between the patient and the palliative team.
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