Nutritional Counseling and Nutritional Supplements

Question: Discuss about the Nutritional Counseling and Nutritional Supplements. Answer: Introduction: In Australia great importance has been placed in providing care to the palliative patients. Cancer patients are the largest percentage of palliative care patients in Australia. They comprise of almost 60% of palliative care in the year 2015-2016. Specialist cancer service along with palliative care is a challenge to almost one third of the population living in rural and regional areas. In the year 2015 1% of the palliative care patients were under the age of 25. In the year 2002 the department of Health and Aging funded a survey which found out that many of the needs of the palliative care patients especially children were not being addressed in the palliative care system. So what is palliative care? Palliative care affirms life and takes dying as normal process (Aslakson, Curtis, Nelson, 2014). In this care, the carers or health professionals are neither postponing nor hastening death. They usually integrate the spiritual and psychological aspect of care into the mainstream care of the patient. Over the course of two decades the management of multidisciplinary medical team for many medical conditions including cancers has increased prominently all around the world. Lets understand the importance of a multidisciplinary team in providing care to a palliative patient by taking an example of a 37 year old female patient who has been diagnosed with triple negative breast cancer in stage T4b N3 M1. The patient has already gone several rounds of chemotherapy after which she has been referred to Mater Cancer Care Centre for palliative care. Metastases have spread to her lumbar, sacral and cervico-dorsal vertebrae and even her pelvic bones. In the OPD (our patients department) she had complained of severe pain in her neck and head. She was later admitted to the palliative care unit for control of vomiting and nausea and also for analgesic titration. Her physical pain was managed according to the WHO pain ladder which was 3 on the ladder. Her psychological pain was also evident as recently she has lost her job and has lost her income. The patient has now lost her house and her children have been sent to live with her relatives. It is quite evident that t hese patients need empathy and psychological support beyond any other medications. For her care, multidisciplinary team of doctors including medical oncology, radiology, surgical oncology, pastoral support specialists and anesthetics along with physiotherapists and nurses are available. Each of these specialists was contributing according to their expertise. ( Bowen,2014), (Hui, Bruera,2015) Palliative care is also discussed as a holistic care with the patient and family centered approach. A multidisciplinary team would mean different in different services. This could be social workers, bereavement counselors, pastoral care workers and occupational therapists. Why do these patients need multidisciplinary medical teams? From this example we can see that a palliative patient require a number of health professionals to work in a collaborative team structure to contribute to the patient care. This can be well explained by the fact that anyone who is facing a terminal illness would requ ire supportive care along with the course of treatment that they are going through for the illness (Hussainy, et al.,2011). Practitioners of various disciplines play a crucial role in the assessment. A multidisciplinary team or MDT is a team of healthcare professionals that are of varied roles and disciplines and are working together in providing optimal care to a patient. The multidisciplinary palliative care teams include assessment of the patient and caring for their families in settings of hospice and care homes. These teams provide extended medical, social, emotional care and support for the patients and their families. The ideal multidisciplinary team would include general practitioners, community health nurses, social workers, Aboriginal Health Workers, physiotherapists, dieticians, psychologists, volunteers, nutritionists and health educators (Isenring, Teleni, 2013). As the Australian population is aging, the number of people with the end stage diseases also increases. The GPs are not able to provide the psychological care that is needed by the palliative patients. These multidisciplinary medical teams hold regular multidisciplinary team meetings that are a way of institutionalized communication. The type of communication and the degree of organisation in these meeting have an impact on the quality of care that the patient is being provided. The decisions made by these health professionals are more effective and accurate than the individuals opinions that would have been taken. These meetings hold a common ground for active discussion on retro specific cases. These specialists are trained and h ave expertise in providing complex care to patients who have life limiting illnesses. Nurses and other health professionals do not limit their care only to the patient but the patients family is also taken care of. They manage the symptoms, provide information and even refer the patient to supportive services. The social workers that are included in these multidisciplinary teams ensure that the patient is an active part in his or her care. They encourage the patient to ask questions, make decisions with their doctors and exercise their right of choice according to their priorities and needs (Munday, Dale, Murray, 2007). Families of these patients go through a range of feelings and emotions such as anxiety, fear, sadness and anger, all they need is the support and counsel that can give them hope with respect and honesty (Hudson, et al.,2008). These workers provide counseling for adjusting to the disease, lifestyle changes that are needed, teaching the patient to maintain relationshi ps with friends and family, managing feelings of anger, depression, reaction to loss and anxiety. Pastoral support staff in these interdisciplinary teams provides emotional and spiritual support to the patient. These services observe the rituals and respect them along with accommodating and facilitating patients religious and spiritual needs. Therefore in a specialist palliative care team the common mode of practice is required, as their roles will overlap but they will still function as a team who work independently but shares information among them to achieve the best care needed by the patient. These teams provide improved care and satisfaction to their clients by efficient use of resources. (Bergman, LAVIANA, 2016) References Aslakson, R., Curtis, J. and Nelson, J. 2014, The Changing Role of Palliative Care in the ICU.Critical Care Medicine, 42(11), pp.2418-2428. Bergman, J. and LAVIANA, A. 2016, Opportunities to maximize value with integrated palliative care.Journal of Multidisciplinary Healthcare, p.219. Bowen, L. 2014, The multidisciplinary team in palliative care: A case reflection.Indian Journal of Palliative Care, 20(2), p.142. Hudson, P., Quinn, K., O'Hanlon, B. and Aranda, S. 2008, Family meetings in palliative care: Multidisciplinary clinical practice guidelines.BMC Palliative Care, 7(1). Hui, D. and Bruera, E. 2015, Integrating palliative care into the trajectory of cancer care.Nature Reviews Clinical Oncology, 13(3), pp.159-171. Hussainy, S., Box, M. and Scholes, S. 2011, Piloting the role of a pharmacist in a community palliative care multidisciplinary team: an Australian experience.BMC Palliative Care, 10(1). Isenring, E. and Teleni, L. 2013, Nutritional counseling and nutritional supplements.Current Opinion in Supportive and Palliative Care, 7(4), pp.390-395. Munday, D., Dale, J. and Murray, S. 2007, Choice and place of death: individual preferences, uncertainty, and the availability of care.Journal of the Royal Society of Medicine, 100(5), pp.211-215.