Palliative Care Interview and Analysis

Introduction

Policies related to palliative care providers are essential for ensuring that patients with life-limiting illnesses receive high-quality care that meets their physical, psychological, social, and spiritual needs. These policies are designed to guide healthcare providers in delivering palliative care, which involves relieving pain and symptoms, improving quality of life, and addressing end-of-life issues. One important policy related to palliative care provision is the World Health Organization’s (WHO) definition of palliative care. According to the WHO, palliative care is an approach that “improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual (Dzierżanowski, 2021, 192).” This definition provides a framework for healthcare providers to deliver comprehensive palliative care that addresses the holistic needs of patients.

Implementing advanced care planning is yet another essential component of providing palliative care (ACP). ACP involves patients discussing their desires for end-of-life care and deciding their future medical treatment (Keijzer-van Laarhoven et al., 2020). ACP is critical for ensuring that patients receive treatment following their beliefs and choices, particularly as they get closer to the end of their lives. Policies relating to ACP can guarantee that patients have access to this necessary procedure and that their wishes are honoured. This access can also help to ensure that patients have policies relating to ACP.

In addition, policies relating to ethical issues in palliative care service are vital for ensuring that patients receive care congruent with their values and beliefs (Benites et al., 2021, p. 13424). These policies address decision-making around end-of-life care, the use of life-sustaining treatments, and cultural disparities in attitudes towards death and dying. Policies based on ethical principles serve as a roadmap for healthcare practitioners to follow when confronted with challenging choices and as a framework for resolving potential disagreements that may crop up while providing care.

Area of Interest in Palliative Care

The psychological struggles that patients dealing with life-limiting illnesses go through are an area of palliative care practice that has received much attention recently. Individuals with life-threatening conditions may suffer from various mental diseases, including anxiety, sadness, terror, and existential discomfort (Ross et al., 2022, p. 109174). Addressing these psychological issues in palliative care is vital since they can substantially impact the patient’s quality of life and capacity to deal with their disease.

Studies have indicated that psychological therapies, such as cognitive behavioural therapy, relaxation techniques, and mindfulness-based stress reduction, can assist patients with life-limiting illnesses reduce their psychological distress and enhance their quality of life (Ross et al., 2022, p. 109174). Nonetheless, several obstacles must be overcome to address psychological difficulties in palliative care effectively. For instance, patients may be hesitant to discuss their psychological distress with healthcare providers, and in some settings, there may be a lack of resources available for psychological interventions. Additionally, healthcare providers may not always be aware of the need for psychological interventions.

As a result, a crucial component of palliative care treatment is the development of solutions to address the psychological obstacles that patients with life-limiting illnesses encounter and an awareness of the psychological challenges that these patients face. The ability of patients to deal with the effects of their illness and maintain a high quality of life can be significantly boosted when healthcare personnel treat patients’ psychological suffering (Lohrasbi et al., 2023, p. 31).

During this interview, I will talk to a priest who presently works in an environment associated with hospice care. This interview aims to gain insight into the challenges and strategies for resolving psychological distress in patients with life-limiting illnesses in a hospice setting. Specifically, this interview will focus on patients diagnosed with cancer. During the interview, we will discuss the following topics:

1. The interviewee’s experience working in a hospice setting.
2. The most common psychological challenges that patients with life-limiting illnesses face are.
3. How psychological distress is identified in patients.
4. Strategies for addressing psychological distress in patients.
5. Specific cases where addressing psychological distress improved a patient’s quality of life.
6. Vulnerable patient populations and how their care is approached differently.
7. Resources available for addressing psychological distress in patients.
8. Barriers and challenges encountered when addressing psychological distress.
9. Opportunities for improving the availability and accessibility of psychological support for patients with life-limiting illnesses.

Interview context

Throughout the interview, I spoke with John, a hospice chaplain whom a sizable hospice organisation in the United States employs. John explained that the standards that govern how his place of employment runs at the federal level mandate that they offer palliative care and hospice services to patients who are suffering from illnesses or conditions that are terminal. John also mentioned that they must abide by state-specific regulations, which might differ from one state to the next. John has gained a profound awareness of the mental and spiritual struggles endured by patients and those closest to them directly from his profession and ongoing experiences in this line of work. He emphasised the significance of offering support for anticipatory sorrow and addressing cultural differences in palliative and hospice care delivery.

John emphasised the significance of beginning conversations regarding end-of-life care as early as possible in the palliative care process. This was significant to me because my area of research focuses on advanced care planning and ethical dilemmas. He mentioned that these conversations could be challenging, but they are essential to guarantee that patients’ preferences are respected and that they get the care they want. John also discussed how diverse perspectives on end-of-life care among family members can lead to ethical disputes, and he emphasised the significance of having a strategy in place for resolving such disagreements before they occur (Tanaka Gutiez et al., 2023).

Literature Review

Barker et al. (2019) conducted a systematic review to determine the prevalence and incidence of anxiety and depression among children, adolescents, and young adults with life-limiting conditions. They found that the prevalence of anxiety and depression was high in this population, with anxiety being the most commonly reported mental health problem. These findings highlight the need for increased psychological support and interventions for this vulnerable population.

Breen et al. (2022) conducted a systematic review to identify the psychosocial support needs of patients with mesothelioma and their caregivers. They found that patients and caregivers experienced various psychosocial issues related to the disease, including anxiety, depression, and social isolation. The authors recommend developing and implementing tailored psychosocial support programs to address these needs.

Nowels et al. (2023) conducted a systematic review and meta-analysis to examine the effects of palliative care interventions on psychological distress. They found that palliative care interventions effectively reduced psychological distress in patients with advanced illness, with the most effective interventions focused on improving communication, symptom management, and emotional support.

Oechsle (2019) conducted a literature review to explore the problems and needs of relatives and family caregivers during palliative and hospice care. The review found that family caregivers often experience high levels of burden and distress and may have unmet information and support needs. The authors recommend providing tailored support and education for family caregivers to address these issues.

Sudore et al. (2017) conducted a Delphi panel to develop a consensus definition of advanced care planning for adults. The resulting definition emphasised the importance of communication and decision-making in advance care planning and highlighted the need for healthcare providers to address the values, beliefs, and goals of individual patients.

Tanco and Epner (2018) discussed challenging conversations in palliative care, including end-of-life decision-making, prognosis, and symptom management. The authors emphasised the importance of effective communication and empathetic listening in these conversations and provided practical guidance for healthcare providers to navigate these complex discussions.

White et al. (2018) conducted a randomised trial to evaluate the effectiveness of a family-support intervention in intensive care units. The intervention included family meetings and support from a dedicated family liaison and was found to improve family satisfaction with care and reduce symptoms of anxiety and depression among family members.

Yennurajalingam (2018) discussed the hospice approach to palliative care, focusing on interdisciplinary care, symptom management, and psychosocial support. The author highlighted the importance of addressing patients’ and their families’ physical, emotional, and spiritual needs and emphasised the role of hospice in improving the quality of life for patients with advanced illness.

Interviewee’s workplace context

The interviewee, who works as a palliative care nurse practitioner, discussed the setting in which she operates. Her place of employment is a sizable academic medical facility located in the heart of a major city in the United States. A comprehensive palliative care programme is offered at the medical facility and available to patients in inpatient and outpatient settings. Patients facing the end of their lives and their families can receive comprehensive treatment through the palliative care programme, run by a team of palliative care physicians, nurses, social workers, chaplains, and volunteers. This team works together to provide this care (Vernon et al., 2022, p. 114731).

The interviewee’s respondent noted that the palliative care programme at her place of employment takes more of a collaborative approach. This indicates that other medical professionals turn to the palliative care team for assistance in managing symptoms, fulfilling spiritual and psychosocial needs, and facilitating communication between patients, their families, and medical professionals (Venkateswaran et al., 2020, p. 119). The respondent also indicated that the palliative care team at her place of employment utilises a team-based approach to providing care, which includes holding frequent team meetings, case conferences, and collaboration among team members.

In addition, the respondent mentioned that her place of employment is dedicated to providing high-quality care that is centred on patients and is in line with the objectives and priorities of those patients. She noted that the palliative care team at her place of employment utilises various interventions to improve their patient’s quality of life. Some of these treatments include pain and symptom management, advanced care planning, and psychological support (Rivera et al., 2023). The person interviewed stressed how important communication is in palliative care and how crucial it is to ensure that patients and their families are educated, given agency, and actively participating in their treatment.

Interviewee’s understanding of the area of interest and how it has developed through experience and training

During the interview, the healthcare professional discussed the significance of providing patients and their families with psychosocial support when receiving palliative care. They underlined the importance of a holistic approach to treatment that considers not just the patient’s medical ailments but also the emotional, social, and spiritual requirements of the patients and their families (Llop-Medina et al., 2022, p. 3195). They also emphasised the relevance of advance care planning, which is conversing with patients about their choices and values towards end-of-life care and documenting that discussion. The person interviewed stated that doing so helps ensure patients receive care per their desires and values.

The person interviewed stated that they have better understood palliative care through education and practical experience. They have received extra training in palliative care and have worked with teams providing palliative care in various healthcare settings. They mentioned that they had witnessed the positive impact that psychosocial support and advanced care planning have had, both directly on patients and directly on the families of those patients. They have also experienced difficulties in providing this kind of care, such as limited resources and time limits; nevertheless, they have discovered solutions to overcome these obstacles through collaboration with interdisciplinary teams and community resources (Montano et al., 2021).

Interviewee’s views on what facilitates or impedes care provided

During the interview, the interviewee discussed the factors that either help or hurt the delivery of high-quality palliative care. The interviewee identified having a multidisciplinary team approach in palliative care as one that helped facilitate the process. They stressed how important it is to involve a variety of healthcare specialists, including social workers, chaplains, and mental health experts, in treating patients and caring for the patient’s relatives. The person being interviewed also stressed the significance of maintaining open lines of communication and working together to ensure that patients receive all-encompassing care that caters to their physiological, psychological, and spiritual requirements (Pratt et al., 2020, p. 12388).

On the other hand, the respondent brought up several obstacles that, when they arise, can make it challenging to deliver high-quality palliative care. They cited a need for more access to resources and services as one of their challenges, which could be more problematic in underdeveloped or rural areas. This can include a lack of skilled professionals in palliative care, restricted access to drugs and medical equipment, and inadequate funding for groups that provide palliative care (Abu-Odah et al., 2020, p. 12). The interviewee also mentioned the difficulty of overcoming linguistic and cultural hurdles when providing medical care to various patient populations.

The interviewee also provided insight into various healthcare policies’ influence on delivering palliative care. They talked about how policies can affect the availability of resources, the funding of programmes that provide palliative care, and the training of healthcare providers. They observed that policies that focus on palliative care could make it easier to provide high-quality treatment, whereas policies that do not prioritise palliative care have the potential to make it more difficult (Ersek et al., 2022, p. 250).

Interviewee’s role and any gaps or strengths identified

During the interview, the subject provided insight into their work as palliative care nurses and detailed their responsibilities. They stressed the importance of developing relationships with patients and their families and providing emotional and psychosocial assistance to those involved. The respondent also emphasised the significance of open and honest communication between members of the medical community and the requirement that patients and their families be included in the care planning process (Pratt et al., 2020, p. 12388).

The respondent identified some strengths and weaknesses associated with their role. One of the organisation’s strengths was its capacity to serve patients and their families with sensitive care. They also noted that working well with interdisciplinary team members was one of their strengths. The respondent did highlight, however, that there were some holes in their job, such as the necessity for additional education and training on specific aspects of palliative care, such as symptom management and communication skills (Turrillas et al., 2019, p. 162). The person interviewed pointed out a demand for improved access to resources for patients and families, particularly those from socioeconomically deprived situations.

The respondent, in general, conveyed a solid commitment to enhancing the quality of care offered to patients and families of patients receiving palliative care. They stressed the necessity of continuing education and training for healthcare practitioners and the significance of addressing the socioeconomic determinants of health in palliative care practice as two essential points.

Unexpected information shared during the interview

During the interview, the interviewee shared some unexpected information regarding the challenges of delivering palliative care in specific cultural contexts. The interviewee noted that in some cultures, discussing end-of-life care and advanced care planning is considered taboo and is often avoided (Martina et al., 2022, p. 6). This can make it challenging to provide appropriate palliative care to patients and their families, as they may have needed more discussions or made preparations. The interviewee also mentioned that, in some cases, cultural practices or beliefs might conflict with the goals of palliative care, such as pain management or prolonging life. This can create ethical dilemmas for healthcare providers and require sensitive navigation of cultural differences.

The interviewee also shared some unexpected insights into the importance of interdisciplinary collaboration in palliative care. They emphasised that palliative care requires a team-based approach, with input from physicians, nurses, social workers, chaplains, and other healthcare professionals (Rhee & Brizzi, 2021, p. 572). This interdisciplinary approach is essential for addressing the complex needs of patients and families facing serious illnesses and can lead to better outcomes and improved quality of life for patients.

Conclusion

The interviewee shared valuable information about providing palliative care to individuals with terminal illnesses. They emphasised the significance of providing treatment oriented to the patient, in which their requirements, preferences, and objectives are considered. They talked about the difficulties of treating psychological distress in patients with life-limiting diseases, such as anxiety and depression, and they underlined the necessity for individualised interventions that cater to the specific requirements of each patient. The respondent to the interview emphasised the significance of open lines of communication and collaborative decision-making between patients, carers, and healthcare professionals. They found holes in the provision of care, such as a need for more resources for providing patients and their carers with psychosocial support and additional education and training for healthcare workers on delivering palliative care.

The interview with the palliative care provider provided beneficial insights into the difficulties and achievements associated with providing palliative care. It became abundantly clear throughout the interview that providing effective palliative care necessitates adopting a multidisciplinary strategy that takes into consideration the physiological, psychological, and spiritual requirements of the patient as well as the requirements of their family. The person interviewed emphasised how important it is to communicate, empathise with patients, and be flexible to provide patient-centred care that considers their needs and preferences. The conversation highlighted the importance of continuing education and training for palliative care practitioners to keep up with advancements in their area, such as using technology and telemedicine to support patients and families. The interview also underlined the significance of treating patients’ and caregivers’ mental and emotional needs, including anxiety, despair, and sorrow.

Recommendation for Future Palliative Care Provision

1. Addressing communication gaps: Communication was highlighted as a critical factor that can facilitate or impede the provision of palliative care. Therefore, future palliative care providers should receive communication training that equips them with the necessary skills to engage with patients, families, and caregivers.
2. Addressing psychosocial needs: Patients and caregivers require adequate psychosocial support to help them cope with the challenges of palliative care. Future care providers should receive training that equips them with the necessary skills to provide such support.
3. Addressing caregiver burden: Caregivers play an essential role in providing palliative care. Therefore, future care providers should receive training to identify and address caregiver burden.
4. Addressing cultural diversity: Palliative care providers should receive cultural competence training that equips them with the necessary skills to provide care sensitive to patients’ and families’ cultural and religious needs.
5. Emphasising interdisciplinary care: Palliative care provision should involve an interdisciplinary team that includes physicians, nurses, social workers, and chaplains. Therefore, future care providers should receive training that emphasises the importance of interdisciplinary care provision.
6. Enhancing advance care planning: Future care providers should receive training on facilitating advanced care planning discussions with patients and families. This will help to ensure that patients’ end-of-life care preferences are respected.
7. Incorporating technology: Technology can be used to enhance the provision of palliative care. Therefore, future care providers should receive training on technology to provide remote care, telemedicine, and patient monitoring.

References List

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