Palliative Care Strategy for HIV and other diseases - FHI 360

20
tive care services can be incorporated into 1) district/provincial outpatient care, 2) district/
provincial inpatient care, 3) primary care, and 4) community- and home-based care.
• Outpatient Facility: Outpatient clinics are often the center of ambulatory care for
PLHIV. Staff may not have been trained or the centers equipped to provide palliative
care. The outpatient clinic is an important site for providing palliative care. In
order to integrate palliative care, the following can be done:
ͦ Develop an interdisciplinary team. Assess and fill gaps in current teams
related to palliative care. Nurses play a very important role in palliative care,
often working as coordinators of care services in a clinic. Social workers,
counselors, and lay workers are very important palliative care providers.
ͦ Train service providers in adult and pediatric palliative care.
ͦ Incorporate palliative care medicines in the service/essential drug list.
ͦ Include standardized pain and other symptoms assessment (e.g., memorial
symptom assessment scale) tools as part of routine patient intake and
follow-up forms.
ͦ Ensure identified symptoms are managed for optimal reduction of patient
suffering.
ͦ Include a psychosocial assessment (including screening for alcohol and drug
use) as part of patient intake and follow-up forms.
ͦ Use client-held record forms where the palliative and other care plans are
documented and updated as needs change; keep a copy in patient file.
ͦ Ensure providers regularly assess pain and other symptoms in all patients,
whether on ART or not. Develop service provider skills in appropriately
classifying pain (e.g., nociceptive and neuropathic).
ͦ Establish a referral network and systems with services that provide
psychosocial support, spiritual care, legal services, and assistance to children.
ͦ Develop supportive counseling services for clients, families, and caregivers,
including bereavement counseling.
ͦ Where possible, provide assistive devices to support home care (e.g.,
wheelchair or bedpans).
• Inpatient Facility: Inpatient departments often care for PLHIV who are seriously
ill or at the end of life. Few inpatient providers have been trained in palliative
care—a shame given the number of PLHIV who are cared for in these departments.
The following can be done to integrate palliative care:
ͦ
Train service providers in palliative care.
ͦ Identify volunteers (often PLHIV or community members) who work in the
inpatient facility and can provide ongoing support.
ͦ Incorporate palliative care medicines on the service drug list.
ͦ Include standardized pain and other symptoms assessment (e.g., memorial
symptom assessment scale) tools as part of routine patient intake and
follow-up forms.