Cross Country Universitys Caregiver Safety Series

End of Life Care

Palliative versus curative care
In healthcare, much of the focus is on curative care. This is as it should be. The goal is for
patients to get better. The objectives of curative care are:
To obtain a cure
To return patients, as much as possible, to normal functioning.
Sometimes, these objectives cannot be met and the patient is considered terminally ill. The
patient or family may have decided to discontinue curative treatment or there may be no
curative treatment available.
The patient's care now becomes palliative. The objectives of palliative care are:
To make the patient as comfortable as possible
To support the family during this end-of-life period.
Importance of pain control
Pain control is an essential part of end-of-life care. Many cancer patients, for example, say
that their biggest fear is having uncontrolled pain before they die. The challenge for healthcare
professionals is to manage pain so that patients can focus on other end-of-life issues.
During this phase, it is important to reassure patients and families about your facility's
commitment to pain control. Both pharmacological and non-pharmacological measures should
be used to ease the patient's pain. Be sure to involve patients and families in deciding what
methods work best to meet the individual needs of the patient.
You should also assure them that opioids can play an important role in controlling pain. Use of
opioids to control pain will not cause addiction and can help the patient to:
Rest better
Be more mentally alert
Avoid depression.
Patients will have been asked about any advance directives when they were admitted. You
should assure them that a "Living Will" or a "Do Not Resuscitate" order will not prevent them
from receiving pain relief as a part of their care.
Patients who might be good candidates for hospice care may also need reassurance. Assure
the patient and family that pain control is one of the main focuses of hospice care.
Sometimes, nursing staff are concerned about giving opioids as often as ordered because of
fears about side effects. Remember that the objective of palliative care is to control pain and
keep the patient comfortable. Higher than usual doses may be required to control the pain
effectively.
Pain relief is the priority for terminal patients.
Caring for the terminal patient
When caring for the terminal patient, you should:
1. Anticipate pain needs and provide relief before the pain becomes severe

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Cross Country Universitys Caregiver Safety Series

2. Remember that larger doses of analgesia may be needed because of tolerance to the
drug and because of the progressive disease state
3. Assess the patient frequently for pain management needs
4. Discuss the pain management plan with the patient and family
5. Assure the family that everything possible is being done to keep the patient
comfortable.
You may have to be creative in finding the best solutions for individual patients, but the family
and patient provide a valuable source of help. LISTEN to your patient and his/her family.
As the disease progresses, the patient may no longer wish to eat or drink. Families find it hard
to see their loved ones stop eating or drinking, and denial of what is happening is common
and understandable. The family needs support during this time and help to understand the
process.

End of End of Life Care Lesson

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Copyright, 2013, Cross Country University.