When is palliative care implemented

Many people remain confused with euthanasia. There is a huge damage associated with a lack of adequate training for opioids use to control symptoms. This gap in training physicians and health professionals in Palliative Care is due to the absence of medical residency programs and quality specialization courses.

The implementation of the first Palliative Care services in Brazil is very recent, and emerged in the late s. Even today, most services are focused on the care of patients with cancer and on the pain management.

There are several challenges to be overcame in order to implement Palliative Care in health institutions. We can take as exemple absence of national policy for pain relief, deficiency in health and community education, concerns about the use of morphine and other opioids, limitations on the supply of other drugs for the relief of pain, deficiency in the training of physicians, lack of financial resources for research and development in palliative care.

The implantation of Palliative Care Services in educational institutions such as University Hospitals is imperative in the current global health scenario. It is the opportunity to combine teaching and assistance ensuring greater dissemination of knowledge to professionals during their training, as well as providing a field for training graduation and postgraduate students.

This article aims to describe the implementation of a Palliative Care Service in a University Hospital. It is therefore a preliminary report of the motivations, achievements and difficulties faced during this process. It is also a training ground for medical and multidisciplinary residents in several specialities.

It stands out for the care of low-income people, chronic patients, seriously ill and with multiple comorbidities in clinical and surgical specialities. It is a reference hospital for bone marrow and solid organs transplantations, with a large number of such procedures. The HUWC Palliative Care Service started its activities in March , after public selection and the recruitment of three physicians trained in Palliative Medicin and one medical coordinator.

The other participants of the team consisted of a nurse trained in palliative care, a psychologist and a social worker. Thus, the service team was composed of four doctors and a nurse, all of them with exclusive hours for the service; a psychologist, partially assigned by the Department of Cardiology and a social worker, partially assigned by the Hemodialysis service, what meens that they were not exclusive of the Palliative Care Service.

This is a consulting team, which is request according to the perception of the attending physician of the patient in the form of a written opinion. The team does not conduct of the patient alone, but guides or suggests tratment options that should be analyzed by the attending physician and may or may not be implemented.

Clinical Cases are discussed in daily manner. In addition, there is a weekly meeting with the interdisciplinary team, where all members participate and share the difficulties, seeking solutions to more complex cases. Scientifics updates are also held at these meetings with classes and discussions of scientific articles. The staff is housed in a room, with a secretariat that receives and distributes the requests of consultation.

In this place, family and weekly meetings are held with the interdisciplinary team. The advantage of this way of team working is that it functions as a rapid disseminator of the philosophy of end-of-life care, as it is in frequent contact with a large amount of hospital staff, contributing to the educating role of care workers.

The disadvantage is having to work with unprepared staff who may have difficulty accepting some aspects of palliative care promptly, requiring some time for this adaptation. In addition to responding to the new requests, the team also makes frequent visits to follow the evolution of the patients, as well as modify conducts or therapeutic plans when necessary.

Family meetings are held together with the assistant team, assisting in the process of physician-patient-family communication. There is also an outpatient clinic in palliative care where patients who have been discharged from hospital as well as other patients referred from the other services that fit the care profile of chronic life threatening patients continued ambulatorial assistance. The daily follow-up of the palliative nurses establishes an important bridge of communication with the unit nursing team and the family that is of fundamental importance for the good progress of the care for the family, reinforcing the objectives and the philosophy of palliative care.

The nurse also sinalize the doctor for a case of greater urgency of intervention. Psychologist follows the cases of patients and families with greater emotional distress and difficulties in dealing with the illness and acceptance of death. Provides systematic psychological care to hospitalized patients and their families.

It also carries out outpatient psychological care, including assistance to bereaved. The Social Service makes a careful socioeconomic evaluation through a social interview identifying the social support network, detecting the demands according to the patients' needs, such as benefitsand referrals to the for the acquisition of medicine and materials.

In the first few months, HUWC's palliative care team was sparked. The consultancies were scarce and related to cancer patients at the end of life, patients of the Intensive Care Unit ICU and communication of difficult news. A common misunderstanding at this stage was that the function of the palliative care team was "persuading" the family to discontinue nutritional, ventilatory, hemodynamic support in a clear confusion between palliative care and euthanasia, and revealing a profound lack of understanding of the basic principles guiding and conduct the palliative care assistance.

This scenario motivated the team to invest in training. The palliative care team actively participated in the clinical sessions of some services to discuss clinical cases, as well as promoted classes with basic notions for medical residents of Internal Medicine. The result of this educational process was the increase in the number of consultation requests as well as a greater qualification of these, as there was an increase in requests to follow up chronic non-oncological clinical diseases, neurodegenerative diseases, hematological and infectious diseases, as well as management of symptom control.

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Does the world need a scientific society for research on how to improve healthcare? Implement Sci. Promotion of improvement as a science. Download references. Special thanks go to the library staff of both the Radboud university medical center and the Norwegian University of Science and Technology, who provided exhaustive feedback, assistance and support in the development of the search strategy. Box , N, Trondheim, Norway. Box , Nydalen, , Oslo, Norway. You can also search for this author in PubMed Google Scholar.

Correspondence to Jasper van Riet Paap. YE and MVD are responsible for the design of the study. JvRP and RS equally contributed in the development of the search strategy, selection procedure and analysis of included studies. JvRP drafted the first manuscript. All authors approved the final manuscript. Search string. PDF 57 kb. Description studies. Summarized description of the methodology, setting and country, number and type of participants, the implementation strategy, and the impact of the strategy of each individual study.

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Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background The European population is ageing, and as a consequence, an increasing number of patients are in need of palliative care, including those with dementia. Methods Using an integrative literature review, we evaluated publications with strategies to improve the organisation of palliative care.

Results From the publications identified, 68 studies with an experimental or quasi-experimental design were included. Conclusions This review is one of the first to provide an overview of the available literature in relation to strategies used to improve the organisation of palliative care. Background The European population is ageing, and as a consequence, an increasing number of patients are in need of palliative care, including those with dementia.

Methods A review of available research literature was considered important to identify current knowledge about this topic. Table 1 Overview of search terms Full size table. Results Study selection Of the initially identified publications, were selected for full-text assessment Fig.

Flow chart. Full size image. Table 2 Effect of strategies specified to setting Full size table. Abstract Background: The number of older people dying in long-term care facilities is increasing; however, care at the end of life can be suboptimal. Publication types Research Support, Non-U. Gov't Review.