Friday January 18, 2019
Hospice care has many objectives when providing care to patients and their family, including helping family members physically care for a terminally ill loved one, providing emotional support for both the patient and their loved ones, and making sure that the patient is as comfortable and pain free as possible. Pain management is a very important focus of hospice care but it is often misunderstood. Many think that hospice care overmedicates on purpose, but it is important to understand that the goal of hospice is to keep the patient as comfortable with the lowest possible dose. Hospice professionals are trained to be able to work with the patient to deliver the right amount of pain medication, avoiding overmedication.
When a patient decides to receive hospice care, it is important for the Hospice Care Team to meet with both the patient and their family to assess medical needs, review the various aspects of hospice care, and get to know the patient’s interests and life history. An individualized care plan can then be designed based on the patient’s medical needs and personal interests. Other areas that will be discussed and included in their hospice plan include pain management and use of medication, and spiritual and emotional support.
It is always important for hospice professionals and family members to be cognizant of the patient’s pain and related symptoms. Symptoms may vary based on the patient and their health issues. Some symptoms may include physical discomfort, anxiety, depressed mood, constipation, nausea, insomnia and other disease related issues. The patient may be asked to rate their symptoms on a scale of zero to 10 - where zero represents no pain and 10 means severe discomfort. If the patient is unable to answer these questions, then the hospice professional will be able to assess various physical symptoms, including vital signs, increased confusion, crying, moaning, being withdrawn, or increased breathing rate, that may indicate the patient is experiencing pain.
Alternative treatments and medications
Pain management does not always involve prescription medication. Some symptoms and behavioral changes such as rapid breathing rates, fidgeting, being withdrawn and crying may respond best to physical comfort techniques like massage, a soft voice, or holding the patient’s hand. Some physical symptoms can also be managed without medication, for example, the use of ice chips may help ease symptoms of nausea. The use of music, pets, aroma therapy and other forms of distraction may also help with relaxation. Visits from family members can also reduce feelings of loneliness and overall anxiety.
A common fear among family members is that their loved one will be “doped up.” Even though many hospice patients will need some type of medication to manage their discomfort, medical professionals work very hard to find the best medication with the lowest dosage that will be beneficial to patients. Common medications include everyday brand name pain meds such as Tylenol and Advil. Also various types of laxatives are used to help relieve constipation, a common symptom treated in hospice care. Prescription medications may be used to reduce inflammation, anxiety, nausea and pain. It is not unusual to use just oxygen to help with shortness of breath.
A major fear of family members is the use of opioids in hospice care. In some cases, opioids can provide immense relief to the patient. However, rest assured that these medications are used at the lowest level possible to maintain pain control. Another misconception about opioid use in Hospice patients is that it will hasten the end of life. Studies have shown that this is simply not true. In fact, good symptom management can mean that the patient lives longer and in comfort.
Hospice is meant to provide the utmost comfort to patients facing life-limiting illness. Sometimes this is achieved through medication and other times relaxation techniques may be enough. Either way, a Hospice team can help you and your loved one determine what care works best. To learn more, please click here or call 215-371-1393.