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Palliative Care: who are the extended team?. David Hughes. What is palliative care?. starts when emphasis changes from curing patient/prolonging life to relieving symptoms and maintaining well-being/’quality of life’ GPs have 1-2 patients with terminal disease at any time
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Palliative Care: who are the extended team? David Hughes
What is palliative care? • starts when emphasis changes from curing patient/prolonging life to relieving symptoms and maintaining well-being/’quality of life’ • GPs have 1-2 patients with terminal disease at any time • tendency to get more personally involved than with any others
What problems arise? • physical • psychological • social • cultural • spiritual
Key to good palliative care? • good communication • close MDT work
Who are the MDT? • palliative care team • GP • district nurse • Macmillan nurse • Marie Curie/Treetops • physiotherapy • OT • oncologist
District nurse • early involvement • mouth care • lubricant +/- stimulant enema for constipation • bed sore prevention (protection mattresses, cushions, incontinence advice, advice on positioning/moving) • catheterisation • Pick line maintenance • LCP implimentation • monitor syringe drivers/analgesiameds • nutrition advice • can refer onwards
Macmillan nurse • palliative care nurse specialists • emotional/psychological support • address anxiety/depression • can refer onwards • MDT go-between
Marie Curie/Treetops • sitters/hospice care • Treetops local, Marie Curie national
Physiotherapist • improve mobility • reduce muscle pain • breathing exercises for cough/SOB
Occupational Therapist • review of aids, appliances, home layout
Oncologist • radiotherapy (e.g bone pain/fractures, rectal pain, ascites, cough in lung Ca, stridor, haemoptysis, cutaneous bleeding, haematuria, SVC obstruction) • chemotherapy
Other contributions… • pinning of lytic metastases at risk of fracture • venting gastrostomy/octreotide for intestinal obstruction • PEG for dysphagia in hungry patient • paracentesis/peritoneo-venous shunt for ascites • surgery for gut fistula • cranial shunt/radiotherapy for raised ICP • necrotic tissue debridement • wound cautery • endoscopic stent insertion for stridor • endoscopy in GI bleeding • blood transfusion • SVC stenting +/- thrombolysis • psychiatric input for refractory anxiety/depression