Palliative and End-Of-Life Care

Palliative care is focused on quality of life and relief of suffering for people with serious illness. It can begin alongside disease-directed treatment and is not limited to the final days. End-of-life care refers more specifically to the period when death is approaching and the goals of care increasingly centre on comfort, dignity, and the patient's priorities. The nurse first identifies what the patient considers intolerable. Pain may be the dominant concern, but breathlessness, nausea, delirium, fear, loss of independence, family distress, or spiritual suffering may be more urgent. Treatment is effective only when it addresses the symptom the patient is actually experiencing. A no-CPR order means that cardiopulmonary resuscitation will not be attempted if cardiac arrest occurs. It does not mean “do not treat.” Oxygen for distress, analgesia, antibiotics, fluids, wound care, communication, and emotional support may still be appropriate when they fit the documented goals of care. The plan should reflect the patient's current wishes, capacity, advance care planning, substitute decision-maker arrangements, and documented goals of care. Revisit the plan when the illness changes or when the burdens...