This handbook, one of a series of books produced African Palliative Care Association (APCA), provides quick-reference information on the principles and practices of palliative care. This is with an aim of providing essential knowledge and skills on palliative care for the care and support providers, heads of health teaching institutions, policy makers and others involved in the care of patients with life-threatening illnesses.
The handbook of palliative care in Africa is underpinned by the philosophy of palliative care. Although the book uses internationally recognised principles of palliative care, it is written for an African audience and therefore discusses models of care appropriate for the African setting.
The handbook of palliative care in Africa is a vital tool for caring for people with life-threatening illnesses. Consequently, it is PEPFAR and APCA’s sincere hope that this book will be a useful tool for practitioners and health planners who are implementing and planning palliative care services for those patients in need of it.
- Palliative care is ‘an approach which improves the quality of life of patients and families facing the problem of lifethreatening 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.’
- It will enhance quality of life, and may also positively influence the course of illness.
- It is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, or antiretroviral/opportunistic Infection (OI) therapy, and includes those investigations needed to better understand and manage distressing clinical complications (WHO 2002).
Palliative care aims at:
- Providing relief from pain and other distressing symptoms;
- Affirming life and regarding dying as a normal process;
- Intending neither to hasten nor to postpone death;
- Integrating the psychological and spiritual aspects of patient care;
- Offering a support system to help patients live as actively as possible until death;
- Offering a support system to help the family cope during a patient’s illness and in their own bereavement;
- Using a team approach to address the needs of patients and their families, including bereavement counselling if indicated;
- Enhancing quality of life, and sometimes also positively influencing the course of an illness;
- Being applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy, radiation or antiretroviral therapy (ART), and being inclusive of those investigations needed to better understand and manage distressing clinical complications;
- Responding to people’s beliefs and practices as well as their social and cultural values.
- A balanced approach to care is needed, balancing the benefits of investigation and treatment against the burdens of possible harm – and thus ensuring quality of life. The following questions should be considered:
- Is there a reasonable chance of benefit to the patient?
- Will the intervention be likely cause harm to the patient?
- Is the intervention a proper use of available resources?
- What are the patient’s wishes?
- Respect for patient autonomy and choice is vital.
- There is a need for open and sensitive communication for all concerned.