From the Guidelines
A comprehensive home palliative care program should include regular visits by a multidisciplinary team consisting of physicians, nurses, social workers, and chaplains who coordinate care based on patient needs, as this approach has been shown to reduce symptom burden, improve quality of life, and increase the odds of dying at home 1.
Key Components of Home Palliative Care
- Pain management using a stepped approach, starting with acetaminophen or NSAIDs for mild pain, then progressing to weak opioids like codeine or tramadol, and finally to strong opioids such as morphine, hydromorphone, or fentanyl patches for severe pain
- Symptom management addressing common issues including constipation, nausea, breathlessness, anxiety, and insomnia
- 24/7 telephone support and emergency medication kits in the home
- Clear advance care planning documentation, family caregiver training, and regular reassessment of care goals
- Emotional support for both patients and families
Benefits of Home Palliative Care
- Reduces symptom burden and improves quality of life for patients with advanced illness 1
- Increases the likelihood of dying at home without negatively impacting caregiver grief
- Enhances patient and family/caregiver satisfaction with care
Importance of Early Integration of Palliative Care
- Reduces morbidity for patients with cancer and enhances patient and family/caregiver satisfaction
- Should be integrated early in the continuum of care to achieve maximum benefit, rather than being provided too late in the disease course 1
Multidisciplinary Team Approach
- Involves nurses, social services, and facilitated communication to improve utilization outcomes and patient-centered outcomes 1
- Has been shown to decrease hospitalizations due to heart failure and improve patients' quality of life and functional status 1
From the Research
Program Components for Palliative Care at Home
The program for palliative care at home typically includes several key components, such as:
- Integrated teamwork 2
- Management of pain and physical symptoms 2, 3
- Holistic care 2
- Caring, compassionate, and skilled providers 2
- Timely and responsive care 2
- Patient and family preparedness 2
Symptom Management
Symptom management is a crucial aspect of palliative care at home, with a focus on:
- Controlling pain and physical symptoms 3
- Managing nausea, fatigue, insomnia, and bowel problems 3
- Improving symptom distress scores 3
Support for Caregivers
Caregivers play a vital role in palliative care at home, and their needs should be addressed through:
- Interventions targeting caregiver quality of life, anxiety, and burden 4
- Providing emotional, psychosocial, and spiritual support 5
- Ensuring round-the-clock access to palliative care services and nursing support 5
Primary Health Care Team Involvement
Primary health care teams can offer a range of services to support palliative patients and their caregivers at home, including: