Palliative care (PC) is a type of specialized medical care provided to seriously ill patients to relieve and manage symptoms, provide support to patients and their families, and improve their quality of life (QOL). The advancement in medicine and nursing and the use of evidence-based practices influence the role of PC in Canada. For instance, a shift from institutional-based care or specialized palliative care units (SPCUs) to home-based care has resulted in an increasing number of medical resources accompanying patients to their homes and improving access to PC. In addition, multidisciplinary teams in SPCUs are now well-positioned to utilize their expertise to collaborate and support each other to meet patients’ unique needs. These significant changes in technology and medical practices enable patients with life-limiting diseases to receive quality care in various settings that previously would require specialized facilities. PC is crucial to symptom and pain control among patients with serious illnesses and life-threatening conditions. It aims to enhance the patient’s QOL and ameliorate symptoms, reducing physical and mental distress. Other roles of PC in Canada include lowering healthcare costs and facilitating healthy bereavement.
PC Services Improve the Quality of Life and Survival
PC helps relieve and prevent suffering by identifying, assessing, and managing pain and other related issues, whether mental or spiritual. Patient care impacts the QOL and correlates with the professional behavior of medical staff in SPCUs (Moran et al., 2021). Enhancing patient-based care through multidisciplinary teams ensures that nurses and physicians remain responsive and respectful to patients’ values, beliefs, and preferences, thereby improving patient participation in the treatment process. In this case, listening to and supporting the patients’ wishes promotes autonomy and leads to more personalized care tailored to their unique needs (Connolly et al., 2021). This also helps clinicians in understanding patients’ experiences and improving the care for the terminally ill. End-of-life experience is depressing, and it is driven by fears of pain, loss of control, hopelessness, or abandonment. Thus, providing care based on empathy, compassion, and genuine kindness help patients feel safe and enhance positive therapeutic relationship based on respect and trust (Moran et al., 2021). Being emotionally connected helps ease patients’ discomfort and grief of living with a life-limiting illness. All these help reduce patients’ fear of being left alone in the end.
PC permits nurses to understand their patients better, emotionally connect and empathize with them. This, in turn, reduces illness-related distress, which is linked with improved QOL and constantly supports survival. Research shows that patients “who received early palliative care (EPC) had better QOL and survival” (Mittmann et al., 2020, p. 11). A group of patients (diagnosed with cancer) who received either regular oncologic treatment or EPC combined with regular oncology treatment reported better health outcomes and less stress than those who received standard treatment alone. In a related study, 160 patients (diagnosed with hematologic malignancies) were randomly selected to receive either PC integrated with standard care or standard medical care only. After six months of treatment, patients who received PC reported increased QOL and fewer symptoms associated with depression than the group that received regular care (El-Jawahri et al., 2017). Thus, these findings add to the increasing number of evidence that shows EPC can help improve patients’ QOL.
Healthcare experts’ competency is crucial to deliver patient-centered PC and to increase the QOL. A study conducted by Mittmann et al. (2020) in Canada reveals that EPC can benefit patients’ QOL. In this case, clinicians from diverse settings were drilled to analytically select patients (with a high likelihood of dying within a year) who would benefit from EPC. The findings indicate that EPC led to more hospital visits and increased use of community-based services. The increased resource utilization of PC services was observed among 80.3% of the subjects in the experimental group and 62.4% of those in the control group (Mittmann et al., 2020). The study also found significant improvement in QOL, mood, and survival among patients who received EPC. The improvement in healthcare access is attributed to improved communication between patients, healthcare providers, and families. Another reason is that formal intervention or system change further increases palliative resource use. In this context, PC links patients with essential resources, such as medical equipment and professional support, and reduces unnecessary hospital visits, which help improve the patient’s survival. Therefore, the QOL is a concept central to PC services.
PC Helps in Symptom and Pain Management
Ameliorating symptoms is another essential role of PC services. PC professionals should ensure the availability of medications and medical equipment for pain control, whether in an SPCU or home setting. Providing requisite drugs and other critical medical equipment, such as hospital beds, professional displacement equipment, and pain relief pumps, is fundamental in PC (Danielsen et al., 2018). This equipment alleviates the patient’s pain, improves care quality, and makes them more comfortable. In other scenarios, some patients opt to receive care at their homes to get emotional and social support from family members. In this case, the necessary hospital equipment should be availed in their homes to support their care. Patients who choose to receive treatment at home should be assigned home care nurses and be in contact with a general practitioner in case of an emergency(Danielsen et al., 2018). Therefore, PC helps improve patients’ symptoms by availing requisite medication and pain control medical equipment in SPCUs and home-based settings.
Nurses play an important role in symptom and pain management, as well as in supporting the mental health of patients. PC’s central role is to assist terminally ill patients to live more comfortably and in less agony. Nurses, particularly the specialist palliative care clinical nurse specialists (SPC CNS), significantly help in symptom management. These professionals help other nurses, and healthcare providers identify and treat symptoms that may be emotional, spiritual, or physical (Connolly et al., 2021). The nurses detect the signs as soon as they occur and recommend the best treatment methods. In case of physical pain, nurses may provide painkillers to help ease the pain, which may be administered orally or through intravenous techniques. In addition, physical pain may be relieved through physical therapies such as stretching, walking, and muscle strengthening through massage (Radbruch et al., 2020). The nurses also offer counseling services to help the patients overcome anxiety and other mental disorders. They also provide spiritual support by availing religious leaders to speak to the patients. Thus, nurses in PC help manage patients’ symptoms and pain while providing emotional and spiritual care.
Symptom management remains one of the central concepts of PC, comprising physical, social, psychological, and spiritual aspects of suffering and aiming at symptom relief. PC provides a multidisciplinary workforce to assist patients in dealing with their conditions. In this context, physicians, nurses, and other professionals ensure early detection, impeccable assessment, and alleviation of physical pain through pain medications and physical therapies (Radbruch et al., 2020). The nurses and social workers evaluate the patient’s mental health and offer counseling services and the necessary treatment interventions to ease the distressing signs. They also provide social support through talking or reading to them. PC also helps assess spiritual problems and offers support by availing of religious interventions through chaplains (Connolly et al., 2021). Therefore, it is evident that most patients who seek PC suffer from acute illnesses associated with immense pain. PC eases the patients’ pain by providing physical, psychological, social, and spiritual support (Radbruch et al., 2020). Thus, PC adopts a holistic approach to practices to improve the patient’s mental and physical condition.
PC Reduces Medical Expenses and Provides Bereavement Support
PC services help in lowering the health costs for terminally ill patients. Healthcare cost remains one of the critical issues for patients with life-threatening conditions (Abu-Odah et al., 2020). However, palliative care consultation (PCC) has been linked with reduced healthcare costs, particularly for terminally ill patients with multiple health comorbidities (May et al., 2018). When palliative care is introduced early, the symptoms can be addressed effectively, and advance planning is initiated. This lessens the number of hospital readmissions and emergency department visits. In addition, its holistic approach lowers the average costs of care because a multidisciplinary team addresses all conditions in one setting. PCC has also been associated with low ICU admissions and reduced hospital stay (May et al., 2018). Most healthcare providers in a palliative setting are skilled in handling the acute conditions associated with terminally ill patients. For example, a specialist palliative nurse may provide more quality and patient-centered care to a critically ill patient than a registered nurse (Carvajal et al., 2019). Thus low readmission rates and hospital stay associated with PC help the patients’ families save time and money.
Family members are integral to PC, and providing bereavement support is critical to people dealing with a loss. PC incorporates spiritual, emotional, and cultural factors of care and provides a support structure to assist families in coping with the demise of their loved ones (Devik et al., 2015). The PC team assesses the individuals in need of bereavement support and refers them to appropriate support. The families may be referred to counseling services and other grief support programs (Radbruch et al., 2020). These services are aimed at helping them come to terms with their relative’s death and move on with their lives. Additionally, PC provides follow-up services with the family members through emails or phone calls to know their progress. In some cases, the PC team may send bereavement anniversary cards to family members to help them commemorate the life of a loved one (Goebel et al., 2017). Hence, PC services are not limited to alleviating the suffering of patients but also extend to offering emotional and social support to family members following a patient’s death.
The cost-effectiveness of PC is critical for better patient outcomes. Due to the low costs associated with PC, patients can receive the high-quality care they need without burdening their families with huge expenses. There is also a high chance of patient recovery when PC is introduced early because of its holistic treatment approach. Quality and patient-centered care reduce a patient’s hospital stay, thus providing adequate space and resources for other patients with acute and multiple comorbidities (May et al., 2018). At the same time, the provision of PC does not end in case of the patient’s death, making bereavement support essential for families. There is a need to offer spiritual and psychological support to ensure that the members cope with the loss. The lack of socio-emotional care may result in depression or other mental disorders; thus, bereavement support is critical to families (Radbruch et al., 2020). PC lessens the financial burden for patients and offers bereavement support for families dealing with a loss.
Research on the role of PC in Canada is of particular importance as it improves the understanding of this service and its principles for patients and medical staff. Furthermore, defining the role of PC from a scientific perspective can address the misunderstandings and common beliefs regarding PC services in the population. PC helps patients with life-limiting illnesses, including optimizing metrics to assess the quality and ameliorate disparities, lower healthcare costs, and facilitate healthy bereavement. In this case, providing a high-quality end-of-life service is best informed by methodologically extensive research efforts that generate a robust and evidence-based body of knowledge. Enhancing this research and education is necessary due to its capacity to direct and support PC and effect changes in practice. Thus, PC is a multifaceted process that comprises several key roles aiming to provide care for people with life-threatening conditions. A team of professionals is involved in providing care for such patients based on the gravity of the ailments and the primary treatment goals.
Abu-Odah, H., Molassiotis, A., & Liu, J. (2020). Challenges on the provision of palliative care for patients with cancer in low-and middle-income countries: A systematic review of reviews. BioMed Central Palliative Care, 19(1), 1-16. Web.
Carvajal, A., Haraldsdottir, E., Kroll, T., McCormack, B., Errasti-Ibarrondo, B., & Larkin, P. (2019). Barriers and facilitators perceived by registered nurses to providing person-centred care at the end of life. A scoping review. International Practice Development Journal, 9(2), 1-22. Web.
Connolly, M., Ryder, M., Frazer, K., Furlong, E., Escribano, T. P., Larkin, P., Carruthers E., & McGuigan, E. (2021). Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: A mixed method sequential explanatory study. BioMed Central Palliative Care 20, 134 (2021). Web.
Danielsen, B. V., Sand, A. M., Rosland, J. H., & Førland, O. (2018). Experiences and challenges of home care nurses and general practitioners in home-based palliative care–A qualitative study. BioMed Central Palliative Care, 17(1), 1-13. Web.
Devik, S. A., Hellzen, O., & Enmarker, I. (2015). “Picking up the pieces”—Meanings of receiving home nursing care when being old and living with advanced cancer in a rural area. International Journal of Qualitative Studies on Health and Well-Being, 10(1), 28382. Web.
El-Jawahri, A., Traeger, L., Greer, J., VanDusen, H., Fishman, S., & LeBlanc, T. et al. (2017). Effect of inpatient palliative care during hematopoietic stem-cell transplant on psychological distress 6 months after transplant: Results of a randomized clinical trial. Journal of Clinical Oncology, 35(32), 3714-3721. Web.
Goebel, S., Mai, S., Gerlach, C., Windschmitt, U., Feldmann, K., & Weber, M. (2017). Family members of deceased palliative care patients receiving bereavement anniversary cards: A survey on the recipient’s reactions and opinions. BioMed Central Palliative Care, 16(1). Web.
May, P., Normand, C., Cassel, J., Del Fabbro, E., Fine, R., & Menz, R. et al. (2018). Economics of palliative care for hospitalized adults with serious illness. The Journal of the American Medical Association Internal Medicine, 178(6), 820. Web.
Mittmann, N., Liu, N., MacKinnon, M., Seung, S. J., Look Hong, N. J., Earle, C. C., Gradin, S., Sati, S., Buchman, S., Jakda, A., & Wright, F. C. (2020). Does early palliative identification improve the use of palliative care services? PloS One, 15(1), e0226597. Web.
Moran, S., Bailey, M., & Doody, O. (2021). An integrative review to identify how nurses practising in inpatient specialist palliative care units uphold the values of nursing. BioMed Central Palliative Care, 20(1), 1-16. Web.
Radbruch, L., De Lima, L., Knaul, F., Wenk, R., Ali, Z., & Bhatnaghar, S. et al. (2020). Redefining palliative care—A new consensus-based definition. Journal of Pain and Symptom Management, 60(4), 754-764. Web.