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Palliative and End-of-Life Care

    The goal of palliative care after discontinuation of active anti-cancer therapy shift from cure and survival to the optimization of physical comfort, psychosocial well being, and quality of life. This phase of care focuses on the alleviation of physical symptoms, cognitive impact, and psychosocial concerns which may diminish the patient’s quality of life.

    Many cancer patients receive treatments to control disease for palliation. During this difficult time, they need ongoing support services at home. There is data that shows that supportive care improves survival in non-small cell lung cancer (Yoong et al., 2013). Early palliative referrals and goals of care discussions improve quality of life and help patients throughout this difficult journey. The goal of end-of-life care after discontinuation of active anti-cancer therapy shift from cure and survival to the optimization of physical comfort, psychosocial well-being, and quality of life and support of the family members. This phase of care focuses on the alleviation of physical symptoms, cognitive impact, and psychosocial concerns which may diminish the patient’s quality of life. How to address these difficult issues for cancer patients remains a challenge and is an art which can be mastered with some techniques and patient centered care, as all patients are very different. Discussing end of life issues such as, “do not resuscitate” order, comfort measures only from active treatment, and transfer to palliative care unit or hospice etc.

    Baile et al. (2000) developed the SPIKES model, which is a “six step protocol for delivering bad news” for patients with cancer. (Baile et al., 2000)

SPIKES model: The Six Steps:

  • Setting
  • Perception
  • Invitation
  • Knowledge
  • Emotions
  • Strategy and Summary