Symptom Management in the Terminal Phase: Turning Challenges into Opportunities
A blog post written by Paul Tait, Content Editor, CareSearch, Flinders University and Lead Palliative Care Pharmacist, Southern Adelaide Palliative Services and Susan Gravier, Research Associate, CareSearch, Flinders University
“Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.” – Isaac Asimov, American science fiction novelist & scholar (1920 – 1992).
Symptoms can be anticipated in the terminal or transition phase referred to by Asimov. How these symptoms are managed influences the person’s comfort and the level of carer stress, and therefore, their ability to die in their home.
Nurse practitioners (NPs) and general practitioners (GPs) are well placed to lead care into the terminal phase. Prescribing for terminal phase symptoms in advance (anticipatory prescribing) is good practice; facilitating good communication between nurses, pharmacists and carers. When the person requires medicines they can be given immediately without any delay, thus avoiding unnecessary stress and escalation of care.
Yet, there are known challenges that can overwhelm the situation. When symptoms are poorly managed, this can shake staff confidence and stress the person and their carer, whilst adding potentially unwarranted pressure on ambulance and acute care services. In many situations access to practical guidance at the point of care can assist care providers to manage these challenges before this happens.
In February 2019, palliAGED relaunched their Symptoms and Medicines pages providing healthcare providers with resources to support prescribing in the terminal phase. This update was required because of changes in availability of external resources, as well as in recognition of the value gained from aligning palliative care support resources so that consistent advice is received and understood.
So, what will healthcare providers find in the revised palliAGED Symptoms and Medicines section? The palliative care literature describes six symptoms that may present or become exacerbated in the terminal phase. These symptoms form the core of the Symptoms and Medicines section and include:
- Nausea and Vomiting,
- Respiratory Secretions, and
- Terminal Restlessness.
Each of these topics is presented in the context of terminal care, supplemented with information on the influence of specific prescribing issues on approaches to managing care, including dysphagia. In a move that aligns available resources, the Symptom and Medicines pages consistently link with the peer-reviewed palliAGEDgp smartphone application (the App), ensuring dosing information is freely accessible in any situation. This App also provides information and resources that support key clinical processes such as advance care planning, managing deterioration and recognising dying, case conferences, and the terminal care management plan.
Recognising that palliative care is everyone’s business and therefore that everyone needs access to support, palliAGED continues to evolve with the aim of ensuring easy and where possible free access to information for all. For many healthcare providers, care for older people in the terminal phase will represent a small component of their workload. As such, access to evidence-based and relevant resources is paramount in helping them with symptoms management in the terminal phase.
While Isaac Asimov noted the transition between life and death can be troublesome, may the management of symptoms be the least of our worries.
Paul Tait, Content Editor from CareSearch, Flinders University and Lead Palliative Care Pharmacist from Southern Adelaide Palliative Services
Susan Gravier, Research Associate from CareSearch, Flinders University