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Palliative Care

Palliative care is a type of specialized health care for patients and families facing life-limiting illness, and advanced stage chronic kidney disease is one such illness.


Palliative care* is a type of specialized health care for patients and families facing life-limiting illness, and advanced stage chronic kidney disease is one such illness.


Palliative care helps patients achieve the best possible quality of life right up until the end of life.


Quality palliative care encompasses the following:


  • focuses on the concerns, hopes, and fears of patients and their families (what matters most);
  • pays close attention to physical symptoms such as pain, nausea, loss of appetite, confusion;
  • considers the emotional and spiritual concerns of patients and families;
  • ensures that care is respectful and supportive of patient dignity and autonomy; 
  • respects the social and cultural needs of families;
  • uses a multi-disciplinary approach that may include social workers, spiritual leaders, pharmacists, dieticians, nurses and physicians.

Palliative care does not necessarily end when someone has died.  Family members may need support as they grieve the loss of a loved one.  Bereavement programs are often part of comprehensive palliative care.


*Adopted from: Canadian Virtual Hospice

Having an advance care plan (ACP) for end of life decision making is important for everyone, regardless of their current health condition. 


Those with an ACP are more likely to be satisfied with their care, will require fewer aggressive interventions at the end of life and are more likely to take advantage of hospice resources or die at home.

Today, there are more ACP resources available for patients than ever before: 


Kidney-specific:

The BC renal care community has developed a comprehensive end of life framework to support the delivery of high quality care for people with kidney disease in the last years, months, or days of their lives. The agency has also prioritized the advance care planning process as an essential part of renal care – at every level. 

The BC Renal Agency has produced a video guide that can help patients understand and prepare for this process. Click here for a detailed video guide.
 

BC Government: 

The Government of BC’s Advance Care Planning page includes:

  • Steps on how to create an advance care plan
  • The advance care planning guide “My Voice: Expressing My Wishes for Future Health Care Treatment” (available in English, Punjabi, and Simplified Chinese)
  • Videos and brochures
  • Information on legislation
  • Links to local resources in each health authority

National Resources: 

The "Speak Up" campaign kit consists of several resources and tools.

Conservative care for a renal patient means choosing not to do dialysis and not to have a kidney transplant. Talk to your renal care provider before you decide if conservative care is the right option for you.


BCPRA's Modality Choices Presentation can provide additional information on conservative care.

 
Fraser Health
fraserhealth.ca: Information on advance care planning & hospice palliative care symptom guidelines

Vancouver Coastal Health
vch.ca: In the search box type in "advance care planning", "palliative care", "end of life care", or "advance directive" for a variety of options.

Providence Health Care
http://hpc.providencehealthcare.org/: Information on palliative and hospice care.

Vancouver Island Health
viha.ca: Information on advance directives.
victoriahospice.org: Victoria Hospice's palliative care education.

Interior Health 
www.interiorhealth.ca/YourCare/PalliativeCare/: A repository of information on palliative care, including advance care planning.

Northern Health
http://bit.ly/2dY4w13: Information on end-of-life/palliative and hospice care.
https://northernhealth.ca/YourHealth/AdvanceCarePlanning.aspx: Information on advance care planning and related topics.

BC Children's Hospital
bcchildrens.ca: To view a variety of pamphlets on grief and palliative care that includes symptom management, see the online A - Z pamphlets section of the Family Resource Library.
Canuck Place Children's Hospice: Offers a variety of child and family support resources. 

BC Hospice & Palliative Care Association 

https://bchpca.org/: Collection of information and local, provincial and national resources related to palliative and hospice care.

 
 

‎For any patient on dialysis, there may come a time when he or she may feel that dialysis no longer improves their quality of life or meets their personal and health care goals. If this happens, the patient has the right to discontinue dialysis treatments and opt for conservative care.

 

If you feel that dialysis is no longer a suitable treatment option for you and would like to stop this treatment, first, it is extremely important to discuss your decision with your loved ones and your care team (kidney doctor, nurse, dietician, social worker, etc.).

 

Your care team will want to understand precisely why you would like to stop dialysis. The reasons to discontinue treatment may include worsening health, depression, changing personal goals, declining quality of life on dialysis, and others. In some cases, your doctor may be able to make adjustments to your treatment routine that may improve your situation and influence your decision to stop.

 

If your decision is final, your care team will be able to explain in detail what happens to your body when you stop dialysis as well as what kind of care you will receive once you stop. Your care team will be available to you regardless of your decision to discontinue dialysis.

 

The decision to stop dialysis can be reversed at any time. However, a patient may have adverse health consequences from a lack of treatment even if dialysis is restarted. If you decide to restart the treatments after stopping them, talk to your care team immediately.

 

Stopping dialysis is not considered suicide. It is a well-recognized and accepted treatment choice that results in a natural death due to kidney failure.

 

In general, when a patient with kidney failure decides to stop dialysis, he or she may expect to live between several days and several weeks, depending on their health condition, while their body naturally declines and eventually dies.

 

Without dialysis, toxic wastes and fluid will build up in the body, and the patient will feel tired and drowsy, eventually slipping into a state of unconsciousness. Death will usually occur from organ failure when the patient is unconscious. Any negative symptoms such as pain, nausea or difficulty breathing can be reasonably controlled with medication that a doctor (family physician, kidney specialist or palliative care specialist) will be able to prescribe depending on a patient's individual situation.

You can find more information on stopping dialysis in this Kidney Foundation of Canada pamphlet. For more information on conservative care see this BC Renal Agency's Modality Choices Presentation

‎In Canada, medical assistance in dying (MAiD) is legal under Bill C-14 passed by the Canadian Government on June 17, 2016.

Under this legislation, doctors in Canada are legally able to provide assistance in dying to competent adults seeking this service who have a "grievous and irremediable medical condition that causes enduring, intolerable suffering". In other words, this means all of the following:


  • a person is suffering from a serious and incurable illness, disease or disability;
  • the person’s decline in capability is advanced and irreversible;
  • this condition is causing the person intolerable physical or psychological suffering, which cannot be relieved in an acceptable manner; and
  • the person’s natural death can be reasonably foreseen.

Talk to your doctor if you, or a loved one, are considering this option and want to know if MAiD or other services may be suitable for your personal situation and needs.

Medical assistance in dying is not the same as stopping dialysis. When a patient chooses to seek and receive MAiD, he or she should expect to die on the day of their choice from a special combination of medications administered to them. To learn more about stopping dialysis, please see the respective section on this Palliative Care page.

In British Columbia, the Ministry of Health and all health authorities have set up web pages that provide comprehensive information on MAiD to the public. Each health authority also has a MAiD Care Coordination Service, Centre or Office that can offer additional advice:

View and download here a basic PHSA information sheet with frequently asked questions about MAiD.


 

*The information in our patient handout materials is provided for educational/information purposes, and to support discussion with your health care team about your medical condition and treatment. It does not constitute medical advice and should not substitute for advice given by your physician or other qualified health care professionals.


SOURCE: Palliative Care ( )
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