SYMPTOMS NOT TO IGNORE: WHEN TO SEE A PALLIATIVE CARE

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Allied Health Professionals (AHPs) are the only health care professionals whose primary qualification is in rehabilitation.

Specialist Palliative Care (SPC) AHPs are involved in the care of individuals with complex and unresolved needs. They are recognised as essential members of all specialist palliative care teams and their core activity is limited to the provision of specialist palliative care.

Their job plan includes the four key elements of the specialist practitioner role:

• Expert clinical practice
• Provision of formal and informal education
• Research audit and development of best practice guidelines
• Service improvement and leadership.

Specialist Palliative Care AHPs require a greater degree of training and expert knowledge. They will have undergone or be working towards a recognised post graduate qualification in palliative care.

Specialist Palliative Care AHPs:

• Work as autonomous practitioners offering holistic assessment, diagnosis and treatment.
• Demonstrate an advanced clinical knowledge of the full spectrum of life limiting conditions and of complex symptoms.
• Create a holistic and person centred plan that acknowledges the psychosocial impact of diminishing function and sets realistic goals that are continually adapted to individual need.
• Demonstrate a high level of clinical expertise to enable the person and their carers to adapt to fluctuating clinical presentation and functional levels.
• Act as an expert clinical resource to generalist and other specialist palliative care providers.
• Utilise advanced communication skills to engage in a variety of highly skilled compassionate and timely communications with individuals with life limiting conditions, their carers and members of the interdisciplinary team.
• Actively engage in building the evidence base to support interventions for people with advanced progressive conditions, collaborating with all relevant research stakeholders.
• Influence and promote strategic initiatives and policy development for palliative care services at local, regional and national level.
• Develop, facilitate and provide education, leadership and mentorship for colleagues and other palliative care providers.

SPC Dietetics:

• Nutritional assessment and dietary planning - Create dietary plans that are realistic and continually adapted to individual need and expectations.
• Management of changing nutritional requirements and/or dietary intake associated with advancing disease.Recognising psychosocial implications and impact on quality of life.
• Discuss ethical and legal issues - in conjunction with the multidisciplinary team, individuals and those important to them that may arise in relation to nutrition at end of life.
• Artificial nutrition support - Provide advice and guidance regarding alternative feeding within the context of advanced disease.

SPC Occupational Therapy:

• Functional Rehabilitation - to optimise independence, prevent deconditioning and encourage participation in daily activities identified as meaningful by the person.
• Environmental Adaptation & prescription of equipment - to create a safe home environment to allow the person to be as independent as possible or to reduce the burden on carers.
• Non-Pharmacological Symptom Management - of fatigue, breathlessness and pain which impact on functional ability.
• Self-Management - education to empower individuals and their carers to cope with difficult symptoms and promote quality of life within advancing disease.

SPC Physiotherapy:

• Functional Rehabilitation - to maintain or improve independence, reducing dependence on carers and encouraging self-management and a sense of control.
• Non-Pharmacological Symptom Management - interventions for pain, breathlessness, fatigue and lymphoedema.
• Exercise Prescription - individual programmes aimed at improving muscle strength and mobility within the context of advancing disease.
• Manual Handling Assessment - to guide carers and other healthcare professionals in safe manual handling techniques and promote a safe environment.

SPC Speech and Language Therapy:

• Functional Rehabilitation - to facilitate a person with a communication difficulty to maintain their personal relationships and to ensure their inclusion in end of life decision making.
• Provision of Alternative/Augmentative Communication Systems - to assist the person to communicate as independently as possible in various environments and to reduce frustration/social isolation.
• Symptom Management of dysphagia - to minimise aspiration risk and maximise the person's comfort, safety and pleasure in oral intake.
• Education - to empower the person and their carers to cope with distressing, rapidly changing communication and swallowing symptoms and to address ethical/quality of life concerns with them.