Palliative care
Introduction
Many societies in the world ensure that they give their elderly, terminally ill and infirm people the perfect care, and this has been going on since the fourth century. Special places such as sanatorium, hot springs, rest house, and Sarai used to be designed specifically to tend to the special groups in this case who are the elderly, infirm, or the terminally ill (Jones, 2013). However, the rise of cancer and the discovery of its incurability in the 20th century led to the need for better ways of tending to the terminally ill or people with advanced illnesses (Hudson, et al 2015). That came with the evolution of palliative care in the 1960s and it has been experiencing major advancements to date. Many countries around the globe have adopted the palliative care approach as a way of tending to their terminally ill patients, patients with advancement illnesses as well as look after their families.
The primary goal that has been guiding the palliative care approach is to provide quality life to the patient as well as ensure that the needs of the patient’s family are catered for (WHO. 2020). Some of the guiding principles that have been guiding palliative care include viewing dying as a normal process and affirming life, it does not postpone or fasten patients death, it provides for ways to reduce pain to the patients be they physical or emotional, it offers support to ensure that patients are active day in day out till they pass on and lastly it supports the patients family emotionally (Rumbold, 2012). Palliative care has an underlying philosophy which aims at placing the respect of the patient and their autonomy at the heart of the practice of clinicians.
When compared to the rest of the countries such as New Zealand and USA, Australia can be termed to be relatively behind in terms of palliative care provision to its citizens (Hynson, & Drake, 2012). Various reasons could be attributed to the low rates of palliative care which include lack of funds to provide formal community care; negative attitude from the community as well as negative attitude from some of the medical team towards palliative care; and lack of awareness especially from the aboriginal groups who perceive western healthcare and medicine not to be acceptable among others. The improved health systems that have led to prolonged lives can also be attributed to the low rates of palliative care since the aging population demands care, and the system is not yet fully adopted for provision of palliative care as well as the rising chronic diseases such as cancer that also demands palliative care. The following paper reviews previous work done on palliative care with a focus on the Australian context.
Literature review
Hudson, et al (2015) have defined palliative care as a family and person-centered approach to the provision of care towards the people who have active, advanced diseases, progressive disease, who have no or little prospect of cure and their probability of dying is higher and to whom a primary goal for treatment is to maximize the quality of life (Hudson, et al 2015). The quality of life is improved by preventing and relieving suffering from the patient through early identification and right assessment of pain and any physical, spiritual, and psychosocial problems in comforting and compassionate care. Similarly, the World health organization has defined palliative care to be an approach that aims at improving the quality of life of patients who are facing problems related to chronic illness and their families through relief and prevention of suffering (WHO. 2020). Hence, palliative care does not only focus on the patient but to the family by offering care and the needed bereavement support (Hudson, et al 2015). Of interesting is that in USA, the definition of palliative care extends to even when a death is not expected, but rather, to when a patient lives with multiple chronic illnesses and has increasing symptoms burden.
Various studies have agreed that when it comes to the provision of palliative care, one approach may not fit for all but the approach varies depending on the severity of the disease prognosis when managing the patient. The health needs of the patients as well as the severity of their disease determines the journey that the patient will have to undergo while receiving palliative care (Mitchell, 2011). Sawatzky et al (2016) recognized the need for having an integrated approach if palliative care is to be provided successfully to the patients. The authors agreed that when palliative care is rooted in the existing care delivery system and maintain collaboration between the multidisciplinary teams, better results could be achieved when it comes to the provision of palliative care.
In relation to this, the National palliative care strategy, which is responsible for the provision of palliative care in Australia supports various approaches when it comes to the provision of palliative care alongside other government-funded programs and projects (Hynson, & Drake, 2012). The strategy recognizes that a great number of Australians are underrepresented when it comes to the provision of palliative care and hence it has adopted a guiding principle that states that every Australian should be able to access quality palliative care (Rumbold, 2012). Additionally, a person-centered approach has been adopted alongside the public health approach to comply with integrated palliative care and enhance collaboration between multidisciplinary teams and as such achieve better results when it comes to the provision of palliative care to Australians (Mitchell, 2011).
Among the various approaches that can be used during palliative care, is the person-centered approach. A person-centered approach focuses on making the whole person visible by prioritizing the satisfaction of existential, psychological, spiritual, and social needs using the same attention that the physical needs are given (Hynson, & Drake, 2012). Various studies have argued that a person-centered approach can only be afforded at an environment convenient and supportive to the patient and one that the family members feel they are welcome at any time and be free with their patients (Rumbold, 2012). It is an environment where the patients feel they are involved directly with palliative care experts. Some studies argue that a person-centered approach is lacking in a majority of the countries especially where it is offered in nursing homes as the nurses there are not trained to deliver palliative care. They hence argue that continued delivery of incomplete palliative care could lead to the suffering of the patients in the last days of their lives and steps should be taken to improve the situation.
On the other hand, other studies argue that palliative care in the Australian context is given based on the geographical location of the patient and depending on the available resources (Rumbold, 2012). Palliative care has been categorized based on the resourcing available and the primary care has been given a clear role when it comes to the delivery of palliative care. In other studies, palliative care is provided based on how the caregiver understands the concept of palliative care and understands the suffering being undergone by the patient and his family.
Patients in Australia have been termed to be given palliative care based on their needs rather than prognosis (Rumbold, 2012). As such, there has been done a lot to ensure that patients with advanced, and life-threatening diseases receive the best care possible and allow them to enjoy their last days peacefully. Palliative care services can hence be present in large hospitals whether there are dedicated palliative care beds or not, consultations to general practice, and standalone palliative care services that provide community-based care (Mitchell, 2011). As such, patients are allowed to move between services according to the complexity of their diseases. Smaller services are allowed to link their services with larger service and this allows referral of patients and advice when complex needs arise (Mills, & Mills, 2016). However, despite the efforts by the national Australian government through the palliative care program, palliative care has not been fully adopted and there remains a large portion of Australian who are not receiving palliative care (Mitchell, 2011). This is due to the various challenges that are present in the country as discussed below.
Challenges in providing palliative care to Australians
Individual and family barriers have been identified to produce a great challenge when it comes to giving palliative care to the Australian aboriginal groups (Rumbold, 2012). Some of them hold misconceptions that palliative care translates to the very last few days of a person and this makes them deny the care. Others hold the misconception that western medicine and healthcare are not acceptable to them and they hold onto their traditional means of dealing with pain as well as bereavement. When it comes to these groups, language and communication have also produced challenges when the government intends to extend the awareness programs to the areas containing the native people.
According to Abel, et al (2013), another challenge occurs to people receiving palliative care in the community or at home. the patients have limited access to palliative care medicines as well as limited access to pharmaceutical benefits scheme that provides subsidized palliative medicines and access to PBS drugs that are readily available in the hospitals but not in the community. Other challenges include the provision of palliative care to all patients especially those living with nonmalignant diseases, negative attitudes towards palliative care by people in primary care, and inadequate specialist workforce (Mitchell, 2011).
Medicalization of death
Although one of the principles guiding palliative care is to normalize death and advice medics to be gentle when it comes to accepting death, medical services are on the other hand trying to find how they can resist death, avoid or postpone it. According to Kennedy et al (2014), the medicalization of death is a form of medical care intended to relieve pain and suffering and some studies argue that it does not postpone or hasten death, while other studies argue that it does. Some studies argue that it is due to medicalization that diseases like cancer can be lived with and the patient survives instead of the cultural perception that views cancer as an illness that brings sudden death (Yuan, & Gao, 2018). It is this concept of allowing patients to live with chronic illnesses that makes some studies argue that medicalization postpones or avoids death. However, it is usually a challenge for doctors as they try and balance technical intervention with a humanistic approach to their patients who are dying (Mitchell, 2011).
In conclusion, palliative care in Australia has remained to be a reflection of how complex the system of health is as well as the diversity of the population of Australia and its geography. Improvements in the health system have allowed people to live through diseases that used to lead to a quick death and people can now live longer and in good health. Chronic diseases can be survived by the patient receiving the best and quality care that helps them ease their suffering. The families of the patients also can receive care that allows them to take care of their loved ones and accept death when it comes. A majority of Australians can take pride in the palliative care that they have managed to receive within the means of the government.