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The views and opinions expressed in our blog series are those of the authors and are not necessarily supported by CareSearch, Flinders University and/or the Australian Government Department of Health.
Pain is one of a range of common symptoms experienced by palliative patients. Keep in mind that a patient with a life-limiting illness can experience, on average, 12 or 13 different symptoms through their disease trajectory.
Pain is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage’. Each of us has a number of influences that affect the way we perceive pain. The important thing to appreciate is that the perception of pain is unique to the individual.
The pathophysiology of pain is complex. Although it may help to classify pain as nociceptive or neuropathic to guide management, the reality is that pain is a syndrome with neuropathic, nociceptive, emotional, and psychosocial overlays. The cause of pain is often multifactorial and can involve the disease, its treatment, previous experience, and pre-existing morbidity. Not surprisingly, the management of pain is complex but it always begins and ends with assessment.
Providing palliative care in rural settings brings unique rewards and challenges. While many aspects of the care that rural practitioners provide are similar to that of our urban colleagues, the nature of practice in small towns and rural settings dictates some significant differences. The likelihood of knowing our patients outside the professional sphere is greater, and we not infrequently find ourselves caring for friends, their families, and colleagues. Absence of direct access to specialist palliative care services mean that much of our patients’ end-of-life care is provided by generalists – GPs, hospital doctors, domiciliary nurses, rural and remote and hospital nursing staff. Geography and distance may require innovative solutions, reliance on telephone consultations, and sometimes admission to hospital earlier than would be the case in urban centres.
The care that people receive as they approach the end of their life really does matter. It matters to the person, it matters to the people who love them, and it is a reflection of our societal values. Everyone is affected by death during their lives and everyone dies; indeed, death is a universal health outcome. We need to do end-of-life care well.
Decision Assist, funded by the Australian Government Department of Health, recognises that GPs and aged care workers should be supported to provide quality end-of-life care to meet the needs of older Australians.
To help support GPs, ANZSPM, as a part of Decision Assist, is promoting a framework of care that is based on a palliative approach and suitable for people in the last year of life and can help guide clinicians to provide high quality end-of-life care focussing on a person’s preferences for care and proactive delivery of holistic comprehensive care.
In its 'Dying Well' report published in September last year, the Grattan Institute said 14% of Australians die in their own home. The option of care at home is often well-received by patients and carers alike. Enablers for people to remain at home include support from their general practitioner (GP) as well as access to good symptom control.
Given the small proportion of people who require support at home in the last days of life and the infrequency of managing this patient group, there are some simple tips for GPs to consider with regards to prescribing medicines. These five tips help the GP to anticipate the barriers to timely access to good symptom control and possibly avoid an unnecessary hospitalisation for an issue that could have been effectively managed in the community.