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End of life care

What Is End-Of-Life Care?

End-of-life care is care that is given to people who are near the end of life. People who are near the end of life have stopped receiving treatments to cure and control their illnesses and have chosen end-of-life care. End-of-life care is aimed at controlling the pain and managing the symptoms of patients with terminal diseases. Patients with terminal diseases can live a much more comfortable life toward the end with end-of-life care. End-of-life care or comfort care for patients with terminal diseases includes hospice care, palliative care, and hospice care in their final days of life.

How Does End-Of-Life Care Work?

End-of-life care works through several steps. The first step is deciding when the patient with a terminal illness needs it. A patient with a terminal illness may need end-of-life care that could last for days, weeks, months, or sometimes more than a year. End-of-life care is given to patients who exhibit the following conditions:

  • Having an advanced incurable disease such as cancer, dementia, neurological illness, heart disease, and kidney and liver disease
  • Being generally frail or having co-existing conditions that mean they are expected to die within six months or less
  • Having been admitted to the hospital on multiple occasions, but symptoms keep on getting worse
  • Having a life-threatening acute condition that is caused by a sudden catastrophic event such as an accident, stroke, or heart attack
  • Having decided to stop receiving treatments to cure the illness and receive care at home instead in a hospital

The next step is identifying the areas where the patient needs care. The first area is practical care and assistance. Practical care and assistance involve assistance with activities of daily living (ADLs) such as bathing, feeding, dressing, moving around the house, and other routinary activities. The next area is comfort and dignity. Comfort and dignity focus on making the patients feel secure and at peace by alleviating their pain and discomfort and also allowing them to spend more time with their loved ones in their last days of life. Another area is respite care. Respite care provides a breather to the primary caregiver while the patient continues to receive care at home or in a facility. The next area is grief support. Grief support involves consultations with bereavement specialists or spiritual advisors to prepare for the inevitable death of a loved one.

End-Of-Life Planning

End-of-life planning or advanced care planning involves communicating the wishes and feelings of patients with terminal illnesses to their loved ones. Their loved ones are made clear of the patient’s preferences for end-of-life care.

There are several things to consider in end-of-life planning. The first thing is to be prepared beforehand. Being prepared beforehand means having an open dialogue about the placement, treatment, and wishes of the patient before the patient’s condition worsens. This process involves getting information about hospice care services, palliative care services, spiritual practices, and memorial traditions.

The next thing to consider in end-of-life planning or advanced care planning is to get financial and legal advice from experts. Financial and legal experts can assist the patient’s family members in drafting legal documents. Legal documents include a living will, a power of attorney, and an advance directive. These documents show the patient’s wishes and preferences for future health scenarios in which the patient may not be able to decide due to the terminal illness.

Another thing to consider is to focus on the values of the patient. Focusing on the values of the patient can help the family members in choosing the right medical decision. The right medical decision is based on the values and beliefs of the patient, which includes decisions on treatment, placement, and death.

The next thing to consider is to address family conflicts. Family conflicts can be caused by the stress and grief family members are experiencing. Family members can have misunderstandings and disagreements on the following things like living arrangements, medical treatment, end-of-life directives, and other decisions. These decisions can be made easier by consulting experts such as trained doctors, nurses, social workers, and hospice specialists.

Another thing to consider in end-of-life planning is to communicate with family members. Family members are encouraged to choose their primary end-of-life decision-maker. The primary end-of-life decision-maker is tasked with managing information and coordinating family involvement and support in order to arrive at clear decisions regarding the agreement or disagreement with life-prolonging treatments.

One more thing to consider is to include children if they are involved. Children can be deeply affected by the sick loved one’s condition or situations beyond their understanding. Activities like drawing, story-telling, and puppetry can help children better understand the situation.

Who Decides End-Of-Life Care?

Patients, family members, and health care providers are the ones who decide on end-of-life care. End-of-life care must involve a care plan. A care plan is a summary of the patient’s health conditions, medications, health care providers, emergency contacts, and end-of-life care wishes. End-of-life care wishes are in the form of advanced directives, living wills, and power of attorney. Through these legal documents, patients can decide how end-of-life care will be done for them in the future.

Families also decide on end-of-life care through a decision-maker, according to the National Institute on Aging (NIA). NIA defines a decision-maker as someone assigned by the family members who will lead the discussion and represent what the family members have agreed to do for their sick loved one. The sick loved one may not be able to make the medical decision due to the a life-threatening illness. The decision communicated by the family members’ decision-maker is still based on their sick loved one’s wishes, values, and beliefs.

Healthcare providers also decide on end-of-life care by being a mediator. A mediator is a professionally trained person to enlighten the family members about several misunderstandings and helps arrive at a common medical decision. Their expertise and experience in end-of-life care are crucial in helping families make the right healthcare decision for their sick loved ones.

Benefits Of End-Of-Life Care

There are several benefits of end-of-life care for patients, according to the National Institute on Aging (NIA). The first benefit is providing physical comfort and better quality of life. Providing physical comfort is making patients feel comfortable until death. Patients can feel discomfort due to the following reasons, such as pain, breathing problems, skin irritation, digestive problems, temperature sensitivity, and fatigue.

The second benefit of end-of-life care is managing mental and emotional needs and issues. Managing mental and emotional needs is important since the patient who is facing death is more likely to develop depression or anxiety. Depression or anxiety is caused by several factors like fear of the unknown, worry about those left behind, or fear of being left alone.

The next benefit is providing spiritual needs. Spiritual needs are as important as physical needs for dying patients. Dying patients may have spiritual needs like finding the purpose or meaning of life, ending disagreements with others, or making peace with life circumstances.

Another benefit of end-of-life care is providing support for practical tasks. Practical tasks include picking up the mail, writing down phone messages, doing the laundry, taking care of family pets, picking up medicine from the pharmacy, and more.

End-Of-Life Care Examples

There are several examples of end-of-life care. The first example is end-of-life hospice care. End-of-life hospice care is compassionate care given to patients with terminal illnesses. Patients with terminal illnesses receive maximum comfort from health care professionals under end-of-life hospice care. End-of-life hospice care or compassionate care aims to reduce the pain and common symptoms related to the physical, emotional, mental, spiritual, and social needs of patients. Patients can also receive counseling, practical support, and respite from end-of-life hospice care. End-of-life hospice care consists of a hospice team of doctors, nurses, home health aides, spiritual guides, social workers, pharmacists, and other hospice volunteers.

The next example of end-of-life care is end-of-life nursing care. End-of-life nursing care is medical care aimed at providing care and comfort to patients through the remainder of their lives. Patients are assisted by nurses in doing daily routines, managing health, and removing the stress that may occur from the patient’s environment. Patients undergoing end-of-life nursing care are the ones who have stopped receiving treatment for their life-threatening illnesses.

Another example of end-of-life care is end-of-life palliative care. End-of-life palliative care is specialized medical care by palliative care specialists and palliative care teams who support patients with life-threatening illnesses. Patients with life-threatening illnesses are assisted in having a good quality of life while under end-of-life care. End-of-life palliative care or supportive care includes other end-of-life therapies like pain and symptom management, family and friends support, physical care and assistance in activities of daily living, and emotional support. Emotional support is also provided by palliative care specialists and palliative care teams after death that is focused on the patient’s family and bereavement, according to a study published in the Ochsner Journal.

End-Of-Life Care Pros And Cons

There are several pros and cons of end-of-life care. End-of-life care has a positive effect on medical practitioners, according to the findings presented at the 46th Annual Oncology Nursing Society Congress. The findings suggest that medical professionals were able to make meaningful differences in the lives of patients and patient’s families, receive positive feedback, and experience working with a hospice team. Another pro is that end-of-life care has brought lower hospitalization rates, ICU admissions, and the number of invasive procedures significantly, according to a study published in the Journal of American Medical Association.

For the cons, end-of-life care can have limitations on medical education. A study published in the Journal of General Internal Medicine states that the current educational practices and institutional culture in medical schools in the United States do not support end-of-life care or patient care education. Thus, students, residents, and faculty members in the United States feel unprepared to provide or teach the key components of end-of-life care, like patient care. End-of-life care can also be a financial burden for patients and families that do not have Medicare, Medicaid, or insurance benefits.

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