Dr Sourav Malhotra
Palliative care is a care given to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. The goal of palliative care is to prevent or treat, as early as possible, the symptoms and side effects of the disease and its treatment, in addition to the related psychological, social, and spiritual problems.
Since no two patients are alike, palliative care treatments are tailored to the individual based on his or her medical needs and his or her wishes for how they want to be treated physically, psychologically, and spiritually.It should begin at diagnosis and continue through treatment, follow-up care, and the end of life.
Palliative care adds life to days rather than days to life.
The goals of palliative care include:
* Treating symptoms, including pain, nausea, breathlessness, insomnia, and other physical issues caused by cancer or its treatment.
* Managing emotional and social needs, including anxiety, depression, and relationship issues
* Addressing practical needs, such as transportation and financial concerns
* Providing support for family, friends, and caregivers
* Addressing spiritual needs or concerns
Who gives palliative care?
Often, palliative care specialists work as part of a multidisciplinary team to coordinate care. This palliative care team may consist of doctors, nurses, registered dieticians, pharmacists, and social workers. Many teams include psychologists or a hospital chaplain as well. Palliative care specialists may also make recommendations to primary care physicians about the management of pain and other symptoms.
Role of Dental Surgeon
The palliative care team consists of specialists in various fields of medicine who provides care and treatment to the patients. A dental surgeon can help to improve the quality of life of the patients. Mouth is the most important organ of expression and it is most often affected in later stages of diseases. Oral cavity is home for a great number of micro organisms which aggravates the disease process. The patients need the help of a dentist to alleviate his discomfort and to live a better life. He can help the patient right from the initial diagnosis of the condition up to the relief of pain in the terminal stages of the diseases.
Comprehensive palliative care will take the following issues into account for each patient:
Physical: Common physical symptoms include pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia. Many of these can be relieved with medicines or by using other methods, such as nutrition therapy, physical therapy, or deep breathing techniques.
Emotional and coping: Palliative care specialists can provide resources to help patients and families deal with the emotions that come with a cancer diagnosis and cancer treatment. Depression, anxiety, and fear are only a few of the concerns that can be addressed through palliative care. Experts may provide counseling, recommend support groups, hold family meetings, or make referrals to mental health professionals.
Practical: Cancer patients may have financial and legal worries, insurance questions, employment concerns, and concerns about completing advance directives. For many patients and families, the technical language and specific details of laws and forms are hard to understand. To ease the burden, the palliative care team may assist in coordinating the appropriate services. For example, the team may direct patients and families to resources that can help with financial counseling, understanding medical forms or legal advice, or identifying local and national resources, such as transportation or housing agencies.
Spiritual: With a cancer diagnosis, patients and families often look more deeply for meaning in their lives. Some find the disease brings them more faith, whereas others question their faith as they struggle to understand why cancer happened to them. An expert in palliative care can help people explore their beliefs and values so that they can find a sense of peace or reach a point of acceptance that is appropriate for their situation.
Oral care in palliative care:
The basic principle of oral care in palliative care (OCPC) is focused primarily on the principle that good oral hygiene is the fundamental for oral integrity. Early clinical diagnosis of the oral lesions or conditions in the palliative patients should be done and appropriate actions must be instituted to minimize pain and suffering by giving the symptomatic relief. The causes of oral lesions may be fungal, viral, bacterial, ulcerative, immunosupression, radiation, lack of oral hygiene, and so on. The common oral problems in palliative patients includes, xerostomia (dry mouth), sore mouth, thrush, swallowing problems, sore lips, tastes/odor, soreness under dentures, heavy mucous, difficulty in speaking and pain from one or more of these problems.
Who pays for palliative care?
Palliative care is often covered by individual health insurance plans. If patients do not have health insurance or are unsure about their coverage, they should check with a social worker or their hospital’s financial counselor.
If you have been referred to a palliative care specialist, your palliative care team can help you and your caregivers understand your diagnosis, treatment plan, and prognosis, which is the chance of recovery. These may change throughout the course of your illness, so continue to have honest discussions with both your oncologist and your palliative care team.Dental professional are the important members of extended palliative team and they have number of key roles, including (a) training of palliative care professionals, (b) management of complex oral problems, and (c) management of specific oral problems. Increased awareness by all health care professionals and of palliative oral care would go a long way in providing relief, comfort, and consolation to terminally ill patients and their families.
(The author is – Bds, Mds (Oral Medicine and Maxillofacial Radiologist)
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