Question

1. Key concepts in palliative care delivery

2. Appropriate utilization of palliative care

3. Utilization of palliative care in the treatment of neurology patients

4. Compare and contrast palliative care and hospice care

5. The business case for palliative care

Answer 1

1.Palliative care is the care provided for the terminally ill and their families,especially that is provided by an organised health service.The key concepts of palliative care are

• It provides relief from pain and other distressing symptoms.
• It affirms life and regards dying as a normal process.
• It offers a support system to help patients' live as actively as possible until death.
• It offers a support system to help the family members cope during the patients' illness and in their own bereavement.
• It integrates the psychological and spiritual aspects of patient care.
• It uses the team approach to address the needs of patients and their families including bereavement counselling if indicated.
• It helps in enhancing quality life, and may also positively influence the course of illness.
• Its applicable early in the course of illness in conjunction with other therapies that are intended to prolong life,such as chemotherapy or radiation therapy, and includes investigations needed to better understand and manage clinical complications.

2.Appropriate Utilization of Palliative Care

Several factors may account for the underutilization of palliative care including confusion about terminology, misperception about its intent and scope, concerns about cost and insurance coverage, and potential mistrust because of perceived economic motives.A lack of phsician comfort with end of life conversations including the fear of depriving patients of hope, can also create a barrier to utilization of palliative care.So as to make the patient to utilize the benefits of Palliative care the health professionals should

• Clarify the decisions are flexible and are ultimately made by a lical hospice program, in conjunction with the patint,his or her family and the primary care physician.
• Explain detailly about the illness trajectories, indicator tools, and current palliative admission guideliness for patients with non cancer diagnosis,promote early communication with patients.
• Contextualize decisions in terms of care planning periodically during routine affice visits.
• Physicians should be well positioned to disuss advance care practices during patients routine visits.
• Stating the prognosis at the first visit:appointing someone in physicisns' office to ensure the advance directives are discussed with patient and his or her family members can help the patients utilize the benefits of Palliative care.

3.Utilization of Palliative care in the treatment of Neurology patients.

The role of palliative care for people with progressive neurological disease such as motor neurone disease, Parkinsons' disease, Multiple sclerosis,patients with other neurological disorders such as stroke,brain injury ,brain tumours may also benefit from palliative care.The palliative care that can be provided are

STEPS	DETAILS
Early integration of Palliative care	Palliatve care should be considered early in the disease trajectory,its timing depending on the underlying diagnosis
Mulidisciplinary team	Asessment and care of patients should be provided bydoctors, nurses,physiotherpist,social workers,psychologists/counsellors.
Communication	Open communication with patient and family members are important.
Symptom management	Thorough differential diagnosis, pharmacological,nonpharmacological management regular riew has to be done.Principles of symptom management inherent to neurological palliative care
Care support	The needs of the carer should be assessed on a regular basis. Supporting carers-before and after death is an isdispensible part of palliative care, as it may reduce complicated grief and improve carers' quality of life.
End of life care	Ongoing, regular discussions with patients are essential because their phsical and cognitive function as well as their preferences can change over time. Professionals should encourage open discussions about the dying process and explain that with appropriate care most patients will die peacefully. Patients should be informed about their restriction to treatment and interventions as well as their wishes for hastened death. Recognizing deterioration that may indicate that patients are in their last weeks and months of life is important for appropriate management
Training and education	continuing education regarding palliative care on neurological disorders to be provided to all health care providers

4.Comparison and Contrast between Palliative care and Hospice care

HEADINGS	PALLIATIVE CARE	HOSPICE CARE
TREATMENT	Can be used alongside curative and life prolonging measures Given to those terminal and non terminal illness Can begin at any stage of the disease	Provides care for terminally ill Most often introduced in last 6 months of life Focussed on improving quality and comfort of remaining life.
ELIGIBILITY	Patient must request palliative care referral from physician.	Patient must be certified as terminally illLoved one must agree to not pursue curative measures Patient must elect to pursue hospice care with a specific hospice organisation.
CARE LOCATION	Most often provided at care facility that is associated with palliative care	Provided at any place the patient calls home.
PAYMENT OPTIONS	Private insurance Medicare State Medicaid	Medicare hospice benefit Private insurance State Medicaid