Eulalee ThompsonSTEPPING THROUGH the front door of the Consie Walters Cancer Care Hospice is just like coming home after a difficult day at work. The airy, wooden-floored living room is tastefully furnished with a cream-coloured settee and works of art. And, behind the settee, dainty off-white curtains flutter to a gentle breeze.
The operators of the hospice were careful to create this atmosphere so that end-stage cancer patients, for whom there is no longer the possibility of a cure, could spend their last days feeling at home while being cared for away from home.
"We treat terminally ill cancer patients. We assess them when they first come in, then we make them as comfortable as possible. It's not really a hospital setting," said Nurse Carol Williams.
Like any other hospice, Consie Walters is a place where terminally ill patients spend their last days. The hospice offers specialised attention known in medicine as palliative care. This is supposed to be supportive and compassionate care focusing on symptom control and the patient's psychological needs.
Dr. Derrick Aarons, palliative care specialist, says that palliative care may be provided in homes, in day care units, in conventional care hospitals or in a specific hospice facility. However, due to its philosophy of providing physical, psychological, social and spiritual care, palliative care needs a number of specialist caregivers whose teamwork provides the basis of this comprehensive care.
Many patients, Dr. Aarons said, will die peacefully as their illnesses do not impact any pain-illiciting structures, but pain management is an important aspect of palliative care medicine. Top-quality palliative care can make the difference between a gentle death or one plagued by terrible suffering and pain. Patients with advanced cancer may suffer pains (bone pain, nerve pain, visceral pain and associated pain). They may also experience shortness of breath, depression, confusion, nausea, vomiting, constipation, anorexia, anxiety and excessive loss of weight.
At Consie Walters, Dr. Aarons said that pain management is effected through the three-step ladder method recommended by the World Health Organisation (WHO).
At step one, the palliative care physician makes use of normal analgesics or pain-relieving drugs (such as aspirin, Panadol, Tylenol); then at step two, weak opioids are used (such as Codeine, Oxycodone) and then at step three, strong opioids are used (such as morphine, heroin, Dilaudid).
Dr. Aarons said that 95 per cent of all cancer pain worldwide can be controlled in this way and that the five per cent treatment failure usually involves metastases (or spread of the cancerous tumour) to remote and difficult to access parts of the brain. However, these difficult cases, he said can be helped with new synthetic drugs (not presently available in Jamaica) and invasive procedures to introduce these drugs into the brain as is done in many advanced palliative care centres in the industrialised countries.
Patients living through their last days and their families also need special counselling. The patient is staring the awesome death in the face, but it is also a very emotional time for the relatives; they must begin to work through the stages of grief and bereavement. Hospice care also offers this kind of compassionate counselling for patients and their relatives.
