While hospice is still an entity mainly associated with illnesses such as cancer, AIDS and multiple sclerosis, an increase in the prevalence of non-communicable diseases (NCDs) may require South Africa to reconsider the connotation of the term ‘hospice’.
Individuals diagnosed with these and other terminal conditions are in need of both continuous care and emotional support. South Africa boasts one of the most advanced palliative care systems on the African continent with an intricate system of hospice organisations and subsidiaries that care for people with terminal conditions.
Terminally ill patients nearing end of life yearn to be comfortable, free of pain and surrounded by tranquility and their loved ones. According to the World Health Organisation (WHO), palliative care is an approach that improves the quality of life of qualifying patients and their families facing problems associated with life-threatening illness, through the prevention and relief of symptoms, the early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual". The main purpose of palliative care is to give a dying patient the best quality of life while dealing with the numerous effects of the illness.
No one should die alone
The majority of palliative care takes place within the patient’s home although a number of hospice facilities that offer in-patient care are scattered throughout the country. Most terminally-ill patients would prefer to die at home rather than in a hospital, providing the palliative care system with a number of challenges in order to enable them to do so. The ultimate goal of palliative care is to provide the best quality of life for terminally-ill patients and their families. Everyone has a right to pass away with dignity and no one, regardless of colour, creed or financial status, should have to die alone and in pain. The psychological impact of impending death is titanic for both patients and their loved ones. The purpose of palliative care does not finish with the administration of medication or the finality of death. It is important to provide support and guidance to all parties involved, to communicate about the tender yet unavoidable issues at hand and to console once mortality has run its course.
Common physical symptoms need to be managed and monitored
When terminal patients near the end of life they may experience severe symptoms that range from physical to emotional. It is important to prevent and manage these symptoms as best as possible while preserving the patient’s quality of life for as long as possible. As death creeps closer, the following symptoms may become more prevalent.
Dyspnea and physical pain
This biased feeling of breathlessness is a common and very upsetting symptom among dying patients. As mortality approaches, palliative care may include the use of on-going infusions to help relieve discomfort. Pain is one of the most widespread and unpleasant of all symptoms, especially at the end of one’s life. Constant, severe pain can cause immense distress to both the patient and the families making adequate pain management tactics absolutely imperative. Clinicians responsible for taking care of the chronically ill and those already nearing the end of life needs to be competent in effective pain management.
Delirium often sets in near the end of life causing severe restlessness and is a symptom that is even more common among the elderly. End of life restlessness often entails tremendous anguish, agitation, anxiety and partial or complete cognitive failure. Terminal delirium is usually treated by strong tranquilizers and forms an unfortunate yet necessary part of palliative care.
As much as dying is a normal part of life, it is never an easy process, especially not if terminal illness is involved. Thanks to palliative and hospice care, South African patients and their families are receiving the necessary guidance in determining not only appropriate medical care but to align the care goals of the individual patients with that of the primary healthcare team while providing immeasurable amounts of moral support as well.