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What is Palliative Care?The World Health Organization (WHO, 2005) defines Palliative Care as:"…an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual". For full definition see www.who.int/cancer/palliative/definition/en/.A palliative care approach is family-focused, and can be useful in alleviating anxiety or distress for the client and their family at any stage of disease progression, from diagnosis until death (Kueblera, Lynna & Von Rohena, 2005; Kristjanson, Toye & Dawson, 2003; Catlin & Carter, 2002). Palliative Care Australia (PCA; 2003) acknowledges that this care may be provided in a range of settings, including the client's home; other community settings such as aged care facilities; designated inpatient palliative care beds in hospices; or acute hospital beds. As these clients are not expected to benefit from curative treatment (Rutledge & Kueblera, 2004; Mashford et al., 2001) the focus is on the clients' comfort, pain control and symptom management; encouraging communication about loss and grief to help relieve psychological distress; and individualising care (Kristjanson, Toye & Dawson, 2003; Good, 2003; Mashford et al., 2001; Szczepaniak, 1996). The challenges encountered in palliative care are numerous and complex. Thus, a range of skills from a collaborative multidisciplinary team are required (PCA, 2003; Mashford et al., 2001). Speech Pathology in Palliative Care"Palliative care can be part of the treatment repertoire of any health worker" (Kristjanson, Toye & Dawson, 2003, p. S41). The expert care provided by a speech pathologist is often valuable for clients receiving palliative care (Mashford et al., 2001).A palliative caseload can encompass both children and adults diagnosed with a range of life-threatening conditions. The most common recipients of palliative care are people who have advanced stage cancer (PCA, 2003; Mashford et al., 2001). Speech pathologists have reported encountering the following palliative conditions in their clinical practice*:
In addition to these specific conditions, a speech pathologist in palliative care may also see clients who are experiencing a decline in their hearing, vision, and/or cognitive abilities related to ageing and/or prescribed drugs, such as pain medication (Mashford et al., 2001). Despite the fact that speech pathologists can be involved in the palliative care of clients with a range of diagnoses, there is a lack of research into the role of speech pathologists in palliative care (Pollens, 2004; Jubb, 2002; Lipman, 2000). Speech pathologists have a wide range of knowledge and clinical experience which they must draw from when dealing with a palliative client (see sections of website relating to specific aspects of care). Speech pathology practices in palliative care are generally based on a combination of personal experience, anecdotal evidence, current best practice standards and organisational practice rather than on formal research* (Lipman, 2000). Speech pathologists should draw from their knowledge of best practice in related areas and apply clinical reasoning skills (Jubb, 2002; Miteff, 2001; SPA, 2000, 2002; Bowman, 2000). (See ETHICS AND RESEARCH section of this website). Pollens (2004) suggests that the Speech Pathologist's role primarily entails the following four areas (p. 694):
Development of this WebsiteThe aim of this website was to outline the available evidence-base and current practice for speech pathologists when dealing with clients who have palliative needs. A literature search was conducted of relevant books, websites, and journal articles (both hardcopy and online), using the CINAHL, AMED, Embase, Medline and ProQuest databases. There was found to be a paucity of research evidence-base regarding the speech pathologist's role in palliative care. This lack of literature has been recognised by a number of authors (Pollens, 2004; Jubb, 2002; Lipman, 2000), as was the fact that speech pathology practice in palliative care is frequently guided by anecdotal evidence rather than research base* (Lipman, 2000). Due to these findings, a clinician survey was also conducted in the development of this website. This entailed obtaining personal accounts (in the form of survey responses) from thirteen practising speech pathologists regarding current speech pathology practice and considerations when dealing with clients who have palliative needs. The speech pathologists surveyed were all currently working, or had recently worked, in the field of palliative care in Victoria.How to reference this website:Gooden, J-F., Jones, C., Mann, A., McDowall, M. & Shugg, J. (2005). Care and Communication: The Role of the Speech Pathologist in Palliative Care. Melbourne: La Trobe University. Retrieved (date), from www.latrobe.edu.au/careandcommunication/References:Bowman, K. (2000). Communication, negotiation, and mediation: Dealing with conflict in end-of-life decisions. Journal of Palliative Care, 16, S17-S24. Catlin, A., & Carter, B. (2002). Creation of a neonatal end-of-life palliative care protocol. Neonatal Network, 21(4), 37-49. Good, P. (2003). Advances in palliative care relevant to the wider delivery of healthcare. Medical Journal of Australia, 179, S44-S46. Jubb, A. (2002). Palliative care research: Trading ethics for an evidence base. Journal of Medical Ethics, 28(6), 342-346. Kristjanson, L., Toye, C., & Dawson, S. (2003). New dimensions in palliative care: a palliative approach to neurodegenerative diseases and final illness in older people. Medical Journal of Australia, 179, S41-S43. Kueblera, K., Lynna, J., & Von Rohena, J. (2005). Perspectives in palliative care. Seminars in Oncology Nursing, 21(1), 2-10. Lipman, A. (2000). Evidence-based palliative care. In A. Lipman, K. Jackson & L. Tyler (Eds.), Evidence based symptom control in palliative care: Systematic reviews and validated clinical practice guidelines for 15 common problems in patients with life limiting disease (pp. 1-9). New York: Pharmaceutical Products Press. Mashford, M., Aranda, S., Ashby, M., Bowman, J., Brooksbank, M., Cairns, W., Currow, D., Hynson, J., Kissane, D., Maddocks, I., Mitchell, G., O'Connor, M., Poole, S., Ravenscroft, P., Robinson, J., & Smith, M. (2001). Therapeutic guidelines: Palliative care, Version 1. North Melbourne: Therapeutic Guidelines Limited. Miteff, L. (2001). Palliative care ethics: Autonomy in aged care. Australian Nursing Journal, 9(6), CU1-CU4. Palliative Care Australia (PCA) (2003). Palliative care service provision in Australia: A planning guide. Retrieved June 10, 2005, from http://www.pallcare.org.au/Portals/9/docs/publications/Planning%20guide2003.pdf Pollens, R. (2004). Role of the speech-language pathologist in palliative hospice care. Journal of Palliative Medicine, 7(5), 694-702. Rutledge, D., & Kueblera, K. (2004). Applying evidence to palliative care. Seminars in Oncology Nursing, 21(1), 36-43. Speech Pathology Australia (SPA) (2000). Code of ethics. Melbourne: The Speech Pathology Association of Australia Limited. Speech Pathology Australia (SPA) (2002). Ethics Education Package. Melbourne: The Speech Pathology Association of Australia Limited. Szczepaniak, L. (1996). Additional team members. In D. Sheehan & W. Forman (Eds.), Hospice and Palliative Care: Concepts and Practise (pp. 41- 49). Massachusetts: Jones and Bartlett. World Health Organization (WHO) (2005, April 13). WHO Definition of Palliative Care. Retrieved Sep 21, 2005, from http://www.who.int/cancer/palliative/definition/en/ | ||||||||||||||||||||||||||||||||||
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