Age-Appropriate Palliative Care for Young Adults

Age-Appropriate Palliative Care for Young Adults in Australia

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Age-Appropriate Palliative Care for Young Adults in Australia

Introduction

The diagnosis of terminal illnesses such as cancer has been reported to be more traumatic than the basic diagnosis. Studies have indicated that terminal illnesses patients have a high degree of unmet psychological and social needs. Such patients are considerably prone to suffering anxiety, depression and traumatic stress (Cleary et al., 2013). Numerous studies accentuate that those patients with secondary diagnosis of cancer exhibit higher emotional distress manifesting in terms of sleeplessness, pain and fatigue. It is important to note that the provision of optimal care for patients with terminal illnesses ought to blend treatment and disease management, and addressing the psychological needs of the patient as well as the affected family members.

While young adults with cancer form a diverse group, there are considerable unifying characteristics to form a distinct clinical entity. The feature unique to young adults with cancer include; grief, psychosocial development phases, a young adult facing death, and bereavement. While the medical and pharmacological interventions of palliative care for young adults are generally similar to those for older adults, there is need to formulate age-appropriate psychosocial and pharmacologic interventions. It is important to note that transitions zones are complex, and so is the young adults’ oncology, placed between childhood and adulthood (Grinyer & Barbarachild, 2011). This paper aims at reviewing the principles of palliative care, and evaluating the unique interactions of young adults with palliative care.

A Reticulate of Palliative and Supportive Care

Palliative care refers to the care given in a bid to improve the quality of life of patients dealing with life-threatening and terminal diseases such as cancer. The fundamental objective of palliative care, also known as supportive care or comfort care is to prevent and treat, as early as possible, the symptoms as well as the side effects of the disease and its consequent treatment (Ness, 2013). Additionally, the subsequent social, psychological and spiritual problems related to the illness are dealt with. Integral to the palliative and supportive care are secondary cancer prevention, survivorship as well as end-of-life care (Friebert & Williams, 2015).

Palliative care involves a composite of approaches that are instrumental in treating the unpleasant symptoms of the breast cancer both emotionally and physically. The provision of conventional pain medication such as prescription painkillers and over-the-counter pain relievers is one of the means to treat symptoms of cancer in palliative care (Ness, 2013). Other approaches include; use of non-medical pain management techniques such as acupuncture, acupressure, and massage, social and emotional support through community groups and online forums, overall wellness and health support through diet and exercise, and religious, meditative, and spiritual activities (Wein et al., 2010)

Personal Perceptions, Behaviors, Values towards Palliative Care

Nurses play a pivotal role improving care for the dying patients and their families through challenging the current approaches and cultural perceptions in end-of-life care. Personal values and perceptions as well as other relational factors have been identified as instrumental in the determination of factors that affect the provision of quality nursing care at palliative situations. The optimum palliative care is considered as an experience that should be free from suffering and avoidable distress for both the patients and their families subject to patients and families wishes, as well as consistency with clinical, ethical and cultural standards. The widely accepted standards for a good death involve symptom management, spiritual wellbeing for the patient and families, and patient-and-family focused care (Zomorodi & Lynn, 2010). Since death is difficult to predict the troubles with prognostication have resulted in frustration with the nurses’ role in palliative care and at the time of death.  End-of-life and palliative care nurses often exhibit moral distress and report that they are uncertain whether they are extending life or bulkpostponing death (Friebert & Williams, 2015).

Perceptions toward palliative care have been reported to be considerably influenced by cultural perspectives that map the meaning through which people appreciate the world and interpret the situations around them. Perceptions and culture are strong determinants of the nurse’s view of the nature meaning and of illness and death, how bad news can be communicated, how end-of-life decisions can be controlled and made (Cleary et al., 2013). Individuals have an internal locus of control that dictates if one believes in a person controlling their fate through their actions. In addition, an external locus of control is an important tool in shaping ones beliefs of whether events take place independent of individual actions and rather the future is subject to fate or luck.

Palliative care identifies and appreciates inter-relationships with others and consequently the individual remain at the core of the values and choices regarding the dying patient. Such factors result in considerable variances in perception, cognitive processes, values and beliefs, and social structures about which individuals are not cognizant of. The nurses and other health workers dealing with palliative care need to identify and adapt to these factors in a bid to ensure that the palliative care is improved (Zomorodi & Lynn, 2010).

Palliative Care Provision Plan for Young Adults

Palliative care needs to address a wide spectrum of issues that should integrate an individual’s specific and special need. The physical and emotional effects of cancer and its subsequent treatment may differ from one patient to the other subject to age, cultural and social background, and supportive systems. A comprehensive care plan will put into consideration physical, emotional and coping, practical, and spiritual issues. The common physical symptoms include pain, fatigue, loss of appetite, nausea, vomiting, shortness of breath, and insomnia (Gill & Duffy, 2010). Many of these symptoms can be alleviated with medicines or by employing other methods, such as  nutrition therapy,  physical therapy, or deep breathing techniques. Additionally,  chemotherapy,  radiation therapy, or  surgery  may be used to shrink tumors that are causing pain and other problems.

It is important to note that the consensus for young adults, aged between 18 and 30 years, is that this group should be pharmacologically treated as adults. Although young adults are at an age of experimentation, there has not been any clinical evidence of new opioids abuse in the young adults’ population. Consequently, there is a greater risk of under-treating pain as compared to the likelihood of abusing drugs. However, there is need to monitor the prescriptions given to young adults closely (Grinyer & Barbarachild, 2011). When it comes to physical pain as well as other symptoms, it is crucial to note that the presentation of symptoms is greatly subject to the cancer and hence the young adult’s symptoms can be alleviates the same way as that of any adult. When an individual is sick, the psychosocial regression is inevitable. However, there is a crisis that typically arises for young adults since there is a clash of their struggle for independence and the strictures of illness. Nonetheless, while in some cultures parents become more controlling and involved, in Australia, there is an inclination to let the young adult take their own medical decisions and are encouraged to be independent in spite of the illness. Studies have shown that death anxiety in individuals confronted with death is proportionate to the length of their unlived life. Majority of young adults, facing death, would feel that they are yet to live their lives richly, and have not fulfilled their potential, which subsequently increases their panic (Wein et al., 2010).

In dealing with emotional and coping, palliative care specialists provides resources to aid the young adult patients and families deal with the emotions that come with a cancer diagnosis and cancer treatment. Depression, anxiety, and fear are only a few of the concerns that can be addressed through palliative care. Palliative experts should provide counseling, recommend support groups, hold family meetings, or make referrals to mental health professionals (Gill & Duffy, 2010). For Practical concerns,  it should be considered that  young adults may have financial and legal worries, insurance questions, employment concerns, and concerns about completing  advance directives. For many patients and families, the technical language and specific details of laws and forms are hard to understand. To ease the burden, the palliative care team may assist in coordinating the appropriate services (Cleary et al., 2013).

Spiritual interventions following cancer diagnosis deals with the fact that young adult patients and families often look more deeply searching for meaning in their lives. Some find the disease brings them more faith, whereas others question their faith as they struggle to understand why cancer happened to them. As an expert in palliative care the nurse can help people explore their beliefs and values so that they can find a sense of peace or reach a point of acceptance that is appropriate for their situation (Gill & Duffy, 2010).

References

Cleary J., Ddungu H., Distelhorst S.R.,Ripamonti S., Rodin G.M., Bushnaq M.A., et al,. (2013). Supportive and Palliative Care for Metastatic Breast Cancer: Resource Allocations in Low- And Middle-Income Countries. A Breast Health Global Initiative 2013 Consensus Statement. ScienceDirect Jounals. Retrieved from < http://www.sciencedirect.com/science/article/pii/S0960977613002178>

Friebert, S. & Williams, C (2015), Pediatric Palliative & Hospice Care in America: NHPCO’s Facts and Figures, National Hospice and Palliative Care Organization. Retrieved from < http://www.nhpco.org/sites/default/files/public/quality/Pediatric_Facts-Figures.pdf>

Gill F. & Duffy A. (2010). Caring for Cancer Patients on Non-specialist Wards. British Journal of Nursing Vol. 19 No 12. Retrieved from http://www.nurse2nurse.ie/Upload/NA6762article.pdf

Grinyer, A & Barbarachild, Z (2011), Teenage and Young Adult Palliative and End of Life Care Service Evaluation, School of Health and Medicine, Lancaster University

Ness S.M. (2013). Palliative Care Helps Cancer Patients Live Longer and Better. Living with Cancer Blog. Mayo Clinic. Retrieved from < http://www.mayoclinic.org/diseases-conditions/cancer/expert-blog/cancer-palliative-care/bgp-20056303>

Wein, S; Pery, S. & Zer, Alona (2010), Role of Palliative Care in Adolescent and Young Adult Oncology, Journal of Clinical Oncology, American Society of Clinical Oncology 0732-183X/10/2899-1/$20.00 DOI: 10.1200/JCO.2009.22.4543

Zomorodi M. & Lynn M. (2010). Critical Care Nurses’ Values and Behaviors with End-of Life Care: Perceptions and Challenges. Journal of Hospice and Palliative Nursing. MedScape MultiSpeciality. Retrieved from < http://www.medscape.com/viewarticle/725160_6.