Moving palliative care from hospitals to the home

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May 13 2020 Posted: 15:34 IST

Author: Michelle Tierney and Tim Jones, Translational Medical Device Lab

Opinion: healthcare services are recognising that palliative care planning must become more integrated into mainstream services

A common perception amongst the general public is that someone receiving palliative care is very close to dying, but this is not always the case. Although people who receive palliative care usually have an advanced incurable illness, such as cancer, dementia or motor neurone disease, many continue to live for several months or years.

Palliative care focuses on providing care that increases a person's comfort and quality of life by managing distressing symptoms, such as pain, and sometimes it can prolong life. Palliative care should be holistic in that it should treat not just the physical aspects of a person’s condition but also support their mental and social well-being.

Who needs palliative care?

Three in every four people in the high-income countries who die could benefit from palliative care. As our healthcare services continue to improve, more and more of us will be living for longer with chronic diseases and cancer, and so will require palliative care to manage the symptoms associated with those conditions. Research has shown that the requirement for palliative care in over 85 year olds could double by 2040.

Given the option, approximately 70% of those with palliative care needs would prefer to die at home, rather than in a hospital or a hospice. Home-based palliative care increases the quality of life of patients and their families. Generally, people with life-limiting conditions prioritise being in familiar surroundings with their families and doing their usual activities. They are not as focused on receiving treatment that will prolong their life as that would likely result in painful procedures and longer hospital stays. Home-based palliative care can also significantly save healthcare costs, and it’s been suggested that it is possible to care for three people in their home for the same cost as caring for one person in a long-term care facility.

Despite people’s preference to die at home, many still die in hospital because of a lack of suitable home-based resources to support patients’ needs. Increasingly, healthcare services globally are recognising that palliative care planning must become more integrated into mainstream services and not left in the periphery as an afterthought.

As a result, efforts are being focused on maximising value from current healthcare resources to improve palliative care and to enable more people to remain at home whilst receiving their care. This will require the establishment of multidisciplinary care teams to offer tailored treatment plans focused on improving quality of life. Advanced care planning is the proactive approach to help ensure people receive medical care that is consistent with their values, goals, and preferences regardless of their health stage, and can avoid unnecessary hospitalisation or unwanted care

Has technology a role to play in palliative care?

In addition to changes in how the professionals collaborate, the role of innovative technologies and devices can also be an important aspect to increasing the practicalities of implementing home-based palliative care. Firstly, technology can allow the patient or their caregiver to manage symptoms independently at home without a healthcare professional and, secondly, technology can provide a way for clinicians to remotely monitor patients' symptoms and arrange a face-to-face appointment only if an intervention is needed. This, therefore, can help cut down on the number of unnecessary journeys patients need to make into clinics and hospitals.

Our research team in NUI Galway are developing an innovative medical device to help people with advanced cancers to manage the symptom of fluid build-up in the chest. One to two people in every ten that get cancer (usually lung and breast cancers) will get fluid building up in their chest, which is called a pleural effusion. The fluid can build up to 1-2 litres and people often get chest pain and feel very short of breath.

Currently, the fluid can be drained with a drainage tube that in put in the chest, and this is usually drained multiple times a week. But less than 10% of patients can drain themselves unassisted and, so depend on the assistance of a public health nurse or home carer to help them drain. The drainage tube can be in place for up 12 months in many patients, and as a result the tubes can become blocked, infected, or dislodged, and the patient must then visit the hospital to solve these issues.

Our research team are developing a patient-centric drainage technology that will allow patients to drain fully independently, and also limit the number of potential visits to the hospital. This will give patients a greater sense of empowerment as they will have a sense of autonomy over their symptom management and it will provide them with the flexibility to drain when it suits their schedule.

This technology will potentially lower the risk of complications, such as infection and blockages, due to an "active" mechanism that will prevent the fluid from reaccumulating and allow the device to be removed in a matter of weeks. Future versions of the technology may also allow for remote monitoring of the patient’s condition through a connected patient app. Our team’s goal is to develop a technology that will allow people with advanced cancer to continue to live active and dynamic lives at home until death.

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