The Psycho-Social Issues in Palliative Care
Title
The literature review of the Psychosocial issues in palliative care. Symptom like neuropathic pain in spinal-cord compression might presents difficulties in palliative care management.
Palliative care is a multidisciplinary and holistic approach that comprises specialized remedial care for sufferers with serious complications (Lugton & McIntyre, 2005).
Palliative care concentrates on offering sufferers with remedy from indications, stress, and pain of serious illnesses; whatever the diagnosis is (Lloyd-Williams, 2003).
The main aim of palliative care is to improve the quality of life for both the sufferers and their family members. In the medical setting, with continued growing age, healthcare providers are worrying more about the aged sufferers than ever. Neuropathic pain can be considered a component of the natural aging procedure, a progressive degenerative condition of the spinal cord (Treede et al., 2008).
In this condition, vertebral bodies throughout the neck region enlarge through bone spur formation, and the intervertebral discs become dehydrated, calcified, and stiff, directing to shrunk disc height. These processes cause abnormal narrowing in the bone, giving rise to the compression of the spinal cord (Dworkin et al., 2003).
Almost every person who survives long enough might develop this kind of symptom, but comparatively, very few people get treated for it. This state is a general cause of spinal cord dysfunction after the age of around 55 (Bennett, 2010).
Treatment is based upon indications that can vary from mild to severe, such as weakness of limbs (Voltz, 2004). Therefore, it is of the utmost importance that healthcare professionals concentrate on this factor. In this context, it is justified to mention that this chosen symptom is proper and specific and also indicates high awareness levels in the perspective of palliative care.
Locate, evaluate and select appropriate literature
A systematic literature review requires a precise search strategy that will allow replication of the search (Polit & Beck, 2012). This research study is, however, purely a qualitative systematic review. The techniques used in systematic reviewing are in a period of swift development.
A good number of systematic reviews still seek experimental effectiveness, but the methodologies currently exist to facilitate the reviewers’ inspection and careful scrutinization of various issues of feasibility, appropriateness, and meaningfulness.
A proper search strategy is also considered a methodology, which is a general plan for addressing a reach question. Methodology is a universal approach to studying research topics that is concerned with theory and philosophy, which compels the research more willingly than the practicalities of information collection and data analysis (Jha, 2008).
Therefore, this section will show the systematic approach carried out to explore and accumulate review articles (Kothari, 2004). Initially, this will present the way instruction was collected and applied key search terms (Fink, 2010). After that the inclusion and exclusion criteria will be presented and the way electronic databases search was performed will be detailed.
This research study is a systematic review. It reviews established research studies and literature that is purely focused on the research question and tries to recognize, evaluate, choose, and synthesize excellent-quality research evidence applicable to the research question.
The author will use relevant papers, applying various databases and citation indexes. This literature review will not use any statistical method for data interpretation. It is purely a qualitative review, adhering to the standards of data collection, analysis, and documentation.
Systematic literature reviews have largely replaced conventional narrative studies and analyses and expert commentaries as the way of summarization of research evidence (BARBARA et al., 2014). A systematic review attempts to achieve the same level of severity and thoroughness for the review of research evidences as must be applied in production of those evidences in the first place (Khan, 2003).
The present literature review is purely based on peer reviewed protocol so that these could be replicated if essential. For this purpose, large numbers of good quality peer reviewed systematic reviews are obtainable in journals over and above from electronic sources and other relevant databases.
The method followed in this review is secondary research, which comprises summaries, syntheses, or collations of previous research. The university database has been accessed and searched thoroughly to find articles related to the topic.
Available literature has been reviewed related to the topic; consultations have also been taken regarding the considerations of this issue from senior and experienced palliative care providers. The university database was accessed by entering the ID and password and then individual databases relevant to this topic.
The existing literature searches were carried out by synthesis of research evidence within the healthcare system. It is very important to use the best research evidence to support decisions taken in clinical or healthcare situations. It helps to improve the quality of clinical decisions and the outcomes for patients, their families, and their communities.
In qualitative research, thorough literature review and evidence-based searches have been found to be the strongest research evidence. In this study, MEDLINE, Cochrane library, CINHALPLUS, and PubMed were searched to better understand this particular symptom that might present difficulties in palliative care management.
The above electronic databases have been searched. The researcher has looked through various reviews, journals and contacted authors in the knowledge field of additional experiments. The Key terms used in this research were:
Palliative care, palliative care and elder adult, neuropathic pain, spinal cord compression, palliative care management, difficulties in palliative care management, dementia and elderly people, elderly people with dementia and neuropathic pain.
An inclusion and exclusion standard was prepared to remove articles that were not eligible for this study. The exclusion and inclusion criterion helps the researcher show the depth and review detail that is not possible to show in a review question (Aveyard, 2010).
Afterwards, addition and elimination criteria were constantly used in every database search, which was rather useful because it helped to collect current and relevant instruction by focusing and guiding literature searches. The inclusion and exclusion criteria used are listed below in the table.
Inclusion and exclusion criteria table
| Inclusion criteria | Exclusion criteria |
| Papers only in English language | Papers in other language, rather than English |
| Talks about psychosocial aspects of palliative care | Papers older than 2000 |
| Talks about the chosen symptoms that might presents difficulties in the management of palliative care |
Primary and secondary data sources were searched to retrieve required review papers. Primary data sources are actual study results reported by researchers, and secondary data sources are those that summarize or describe others’ work.
Secondary data have been recognized as best place to initiate a research because it offers a broad summary of information associated with the topic and help improve the research problem and questions. Secondary data sources can have negative impact to literature review because it is difficult to understand whether the obtained information is biased or not. Research helps the healthcare professionals to construct knowledge by offering evidence for medical practice.
Introduction
This paper will illustrate a chosen symptom that represents difficulties in palliative care management and investigate current literature, research, and practice associated with this symptom. It will then include a critical evaluation of the investigation’s findings and propose a treatment regimen using client groups from the practice area that is both scientific and innovative.
The selected client group here is the elderly with dementia. This paper will also include necessary assessment data, multidisciplinary involvement, and interventions. It will provide an opportunity for further research. Treatments and medications have a palliative effect if they relieve indications without having a healing effect on the basic cause or disease.
As the primary goal of palliative care is to improve the quality of life of the patients by healing their symptoms of pain or serious illnesses, then concentrating on this issue of neuropathic pain and spinal cord compression is very much significant and necessary symptoms to be taken care of.
Palliative care is offered as extra support layer along with curative treatment and hence it is appropriate at any stage and age in serious illnesses. Basically, palliative care alleviates the adverse effects of the curative treatments, for example: relieving from pain, nausea associated with surgery or chemotherapy and so on.
Body
Neuropathic pain is considered as a general and strictly disabling state, which affects millions of patients worldwide. Lorenz et al have demonstrated the effects of palliative treatment of spinal cord compression. They have summarized few recommendations for palliations of metastatic spinal cord, these are: for the patients with metastatic spinal cord prompt management favorably affects the consequences and should be offered to the same patients.
Patients who are not paralytic and ambulatory, combination of high steroid dosage with radiation need to be administered. High dosage dexamethasone is also prescribed as an addition to the radiation therapy in restoring ambulation after the treatment, but it poses comparatively high occurrence of adverse effects.
Surgical interventions are indicated for the patients with spinal instability, spinal cord compression, progressive neurological deterioration from bony compression and collapse, inflexible pain and breakdown of conservative treatment.
Progression of neurological deficit when patients are getting radiation is considered as surgical stabilization indication. In case of spinal instability or bony compression, surgery needs to be performed prior and then subsequently radiation (Lorenz et al., 2008).
Henwood has summarized the painful cervical spondylosis with myelopathy, which is sometimes paralyzing too. They have illustrated the assessment, diagnosis, management, and medical management, and surgery, preoperative and postoperative nursing care.
The researchers have mentioned the context of the discussion regarding their expectations prior to, during, and after surgery. Explanations of complications, potential risks, and expected consequences are also necessary.
They also emphasize on the encouragement to the patients so that they can strive to be in their finest possible physical condition. In this case of palliative care concentrating on these aspects are of utmost importance. Providing patients with important information like: cessation of smoking prior to surgery or stopping anticoagulant administration, advice them to create arrangements for the assistance at home after discharge comes under palliative care.
Researchers have also mentioned postoperative accountabilities, which comprise neurological assessment, pain management, monitoring procedure-associated complications, mobilization, discharge education, constipation prevention, and incision care, which all fall under palliative care.
They also mentioned that postoperative mobility and ambulation are essential to assist in controlling the patient’s pain and diminishing the complication risks related to bed rest. Thus, this paper has also supported the idea that neuropathic pain might present a complication in palliative care management (Henwood, 2011).
Indications and pain management are said to be an essential component of palliative care. Various people rate palliative care as the most important factor during their treatment, whether at residence, in hospital, or in assisted care homes.
The care specialists communicate and serve the patients to care for and manage indications and pain in a coordinated plan. Often, a palliative care nurse or doctor can recommend alternatives to general practitioners that offer better management of pain consequences.
Apart from pain symptoms which can also present difficulties in palliative care includes fatigue, frustration, difficulty swallowing, difficulty breathing, lack of appetite, hopeless, helpless, constipation and confusion. Generally patients fear being in pain.
Pain is said to be a complicated experience made up of different psychological and physical factors. Expecting that the pain will get worse may make the situation more painful. It is comparatively difficult to decide or think or make any decision when someone is in pain or afraid that the pain may return.
The goal of pain management in palliative treatment is to make the patient feel pain-free as much as possible and make sure that pain is kept under control subsequently (Chang, Lim, Lee & Kim, 2011).
Few recommendations to control such pain includes application of pain medication, maintaining pain diary, physical aids, application of warm or cold packs, frames to keep blankets or cover off a painful region, supports at the back to make the sitting position more comfortable, consult with physiotherapist who advices on the available service options, position patient well and so on.
In this paper the selected symptom is neuropathic pain and the target patients are the elderly people with dementia. Achterberg et al. have mentioned about management of pain in dementia patients.
They have mentioned that out of almost 35million dementia sufferers 50% of the patients regularly experience pain. In spite of this, pain treatment and current assessment within the dementia patient group are insufficient.
Along with the distress and discomfort because of the pain, this is often an underlying reason for behavioural indications that can initiate improper treatment with antipsychotic drugs (O’Hare, White, Passmore & Jackson, 2003.).
Pain contributes to further complications in care and treatment. The review by Achterberg et al. illustrates four main points of views of the management of pain in dementia and offers recommendations for research and practice (Achterberg et al., 2013).
They have mentioned about considerable doubt in literature on the dementia neuropathology impact on perception of pain and processing in other dementias and Alzheimer’s disease. The next viewpoint considers the pain assessment in dementia (Davies, 2012).
This is particularly challenging because dementia individuals have limited capability of self-reporting, which means evaluation relies in greater part on observational methods. Various tools are obtainable, but their clinical utility and psychometric qualities are doubtful.
According to the researchers, the evidence for well-organized treatment with analgesics is also restricted, with few statistically well-controlled trials. The most capable evidence supports the application of stepped management approaches and specifies the pain benefit and behavioral interventions on important indications.
They have also debated further complications in pain management because of the lack of proper education and training for healthcare professionals at various levels where evidence-based management is directly required (Rantala, Kankkunen, Kvist & Hartikainen, 2012). A comprehensive approach is required to address current improper pain management in dementia.
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