Even though it may be months or even years before they’re close to the end of their life, a patient should ideally enter palliative care as early as possible.
“It's better to have been referred early, because there's a lot that can be done, and that’s also why it's important to recognise deterioration,” says Palliative Care Clinical Nurse Specialist, Claire Paynter.
“It helps to review patients, care needs and goals for that person, talking with the family and GP, and starting a palliative care pathway.
“So, you're changing the focus from treating everything to comfort care.”
Deterioration refers to signs of a person’s decline or reduced state of health.
Clinicians and carers should be able to determine when changes occur that signify a patient is moving closer to the end, and it’s crucial for offering the best care and support for each stage.
Identifying what stage of illness people are at will determine what clinicians need to consider. This becomes urgent when the patient is close to dying and wants to be at home, or to be with loved ones. Having an ongoing care relationship for some time before the changes occur will really help.
Closer to the end, not recognising dying - especially in chronically ill, older patients - delays acknowledgement of the limitations of treatment, appropriate decision making and the planning of comfort care.
Claire suggests asking the ‘surprise’ question.
“You should think, ‘Would I be surprised if this person died in the next few months, weeks or days?’,” she says.
“And if you're not surprised, then maybe they might need to step up their palliative care or start looking down that pathway.”
Listen as Claire gives an overview of deterioration.
General indicators of poor or deteriorating health can start weeks or months before a person dies, and include:
Deterioration might be occurring if they are:
Claire recommends tools such as the Supportive and Palliative Care Indicators Tool (SPICT-4ALL) or the Australia-modified Karnovsky Scale (AMKS), which make it easier for care staff, individuals and their families to help to recognise signs that a person’s overall health may be declining.
Finally, she points out that not everyone needs specialist palliative care at the end of their life but can be looked after with palliative care from general medical teams.
“It's important to recognise that not everyone who's dying needs specialist palliative care,” she says.
"If someone is frail and aged and has no complex symptoms, they don't always need to have a specialist palliative care involved.”
Two key resources are available from HammondCare for those looking to learn more about palliative care.
For other helpful ideas, check out these HammondCare links: