Principles of patient-centered care in control of terminal symptoms
Journal
Journal of Clinical Gerontology and Geriatrics
Journal Volume
3
Journal Issue
3
Pages
87-88
Date Issued
2012
Author(s)
Abstract
Age-friendly health care accentuates the need to provide terminally ill elderly patients with “safe and cost-effective services,” and symptom management remains a top priority in hospice palliative care. 1,2 Whether the disease-oriented model that guides the assessmentsandtreatmentoftheclinicalsymptomsofterminalpatientsis compatiblewithpalliativecareisanissuedemandinggraveconcern. Both single- and cross-disciplinary task groups have been established to assess constipation and to examine multidisciplinary collective clinical experience for chronic cough. However, it should be noted that the clinical manifestation of terminal cancer patients is predominately marked with a common pathway resulted from multi-organ system failure and encompassing an average of nine symptoms. Neither constipation nor chronic cough should be treated as an independent symptom impervious to the influence of other coexisting symptoms. Moreover, both constipation and chronic cough are unrelated to the primary tumor site. 3 In terms of symptom assessment, the terminal and frail status should therefore be granted priority for consideration, and the application of any invasive diagnostic procedure needs to be carefully evaluated so as to avoid any potential damage it may cause. Pharmaceutical treatment should be guided by the principles of simplicity and safety, and any drugs that could aggravate the symptoms must be suspended when the disease proves incurable. Also to be noted is that opioid-based symptom control, assessment, and treatment should take into careful consideration of the relationship between morphine and the symptoms. Assessment of chronic cough in terminal patients, for example, should find its prerequisite in the inefficacy of morphine, and that of constipation should first rule out morphine as the cause of the symptom. Symptom control and the physical–psychological adjustments in terminal patients are marked with a positive correlation. 3 In
SDGs
Other Subjects
clinical feature; disease association; disease control; dying; editorial; hospice care; human; medical practice; palliative therapy; patient assessment; patient care; patient safety; prediction; priority journal; quality of life; social support; support group; survival time; terminal disease
Type
journal article