การดูแลแบบประคับประคอง (Palliative Care) สำหรับผู้ป่วยและครอบครัว

Palliative Care is widely recognized abroad, especially in Western countries, and is becoming more known in Thailand. However, caring for this group of patients, particularly near the end of life, still requires increased knowledge and understanding to help patients and families remain calm, understand, and cope with the symptoms that arise.
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<h2 style="color: #008080">What is Palliative Care?</h2>
Palliative Care is care focused on improving the quality of life for patients and their families by reducing suffering physically, mentally, socially, and spiritually. It is care provided alongside curative treatments aimed at eradicating the disease. Palliative care always considers the needs and wishes of patients and their families.
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<h2 style="color: #008080">Palliative Care&#8230; is not just care for terminal patients</h2>
Rather, it is a broad approach to care starting from when patients first face life-threatening illnesses, covering care up to the end of life. It is holistic care from the beginning until the final stage.
When mentioning patients receiving palliative care, people may think of hopeless patients waiting for death, near death, unable to receive any care or treatment. However, in reality, we can help alleviate various symptoms even though the disease itself cannot be completely eradicated through palliative care.
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<h2 style="color: #008080">Principles of Palliative Care</h2>
Palliative care is provided alongside curative treatment with the following important principles:
<ul>
<li>Caring for both the patient and the family</li>
<li>Thorough and comprehensive patient assessment, focusing on reducing suffering from physical symptoms such as pain, breathlessness, fatigue, nausea, vomiting, and psychological symptoms such as depression and anxiety</li>
<li>Striving to allow patients to reach the end of life naturally, without hastening or prolonging death</li>
</ul>
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<h2 style="color: #008080">When can palliative care begin?</h2>
It can begin as soon as the patient faces a life-threatening illness, gradually playing a larger role as the disease progresses and symptoms increase, continuing until the patient passes away. It also includes supporting the family’s grief and loss.
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<h2 style="color: #008080">Appropriate places for palliative care</h2>
Palliative care can be provided at home, in hospitals, or in well-equipped healthcare facilities, depending on the patient’s condition at the time. If the patient has severe symptoms, such as infections, hospital care may be necessary for treatment or intravenous medication. Once the patient’s condition stabilizes, care can continue at home or in a suitable facility, depending on the patient’s status and family context.
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<h2 style="color: #008080">Understanding symptoms of patients near death and basic care</h2>
As the disease progresses, it is important to accept the reality that no one can avoid death. The question is how to ensure the dying person passes without suffering, and the family can prepare emotionally for the great loss. Understanding symptoms that may occur in patients near death can help families and caregivers cope better, as follows:
<ul>
<li>Fatigue, weakness, lack of strength, inability to perform daily activities as before</li>
</ul>
As the disease progresses, the patient’s ability to perform daily activities gradually decreases. The patient may be unable to climb stairs. Therefore, if cared for at home, it may be necessary to arrange for the patient to sleep on the lower floor and provide equipment to assist with urination and defecation nearby.
<ul>
<li>Decreased food and water intake</li>
</ul>
Reduced eating and drinking may cause concern for caregivers and families, fearing hunger, malnutrition, and suffering. However, decreased intake is due to disease progression, which reduces the patient’s ability to swallow and lowers bodily needs. There is no evidence that intravenous or tube feeding improves strength or prolongs life in dying patients. The benefit of intravenous or subcutaneous fluids is still debated; it may help somewhat but has not been shown to clearly extend life.
<ul>
<li>Changes in consciousness</li>
</ul>
Patients may become drowsy, sleep more, or become confused, with altered sleep patterns, restlessness, agitation, delirium, moaning, or hallucinations. These symptoms may be mistaken for pain. If restlessness or agitation is severe, medication may be needed to relieve symptoms.
<ul>
<li>Abnormal breathing</li>
</ul>
Patients may experience changes in breathing such as gasping, open-mouth breathing, rapid breathing, or alternating fast and slow breaths. This is caused by impaired brain control of breathing and possible mucus accumulation due to reduced swallowing ability. Patients may have noisy breathing. Initial care includes positioning the patient on their side and possibly using oral suction devices, but deep suctioning into the throat should be avoided as it may disturb the patient.
<ul>
<li>Cold or discolored extremities</li>
</ul>
At this stage, blood flow to body parts decreases because the heart pumps less effectively. This may cause the heart to beat faster, blood pressure to drop, cold or bluish/darkened hands and feet, mottled skin, and weak pulse.
<ul>
<li>Incontinence of urine and stool</li>
</ul>
Due to nervous system dysfunction and relaxed sphincter muscles, patients may lose control of urination and defecation. Catheterization should only be used when necessary to minimize patient disturbance.
<ul>
<li>Incomplete eye closure</li>
</ul>
Patients near death may lose fat behind the eye sockets, causing the eyeballs to retract and eyelids to close incompletely, leading to dry eyes and corneal ulcers. Artificial tears or eye ointments can be used to keep the eyes moist.
However, patients may still hear and recognize conversations even if they cannot respond. Families can express love, care, and address the patient’s concerns to provide comfort. It is also important to speak respectfully and avoid conflicting conversations near the patient.
The time near death is difficult for both patients and families. We hope for strength to get through this hardship, fostering love, understanding, and stronger bonds between them.

Palliative care for terminal cancer patients or patients with incurable diseases is an option that helps patients avoid suffering from treatments and manage the symptoms that arise in the best possible way.

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