Shinde Tanvi, Damani Anuja, Ghoshal Arunangshu, Muckaden Mary Ann, Deodhar Jayita
Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India.
Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
Indian J Palliat Care. 2022 Jan-Mar;28(1):120-123. doi: 10.25259/IJPC_14_2021. Epub 2022 Feb 1.
The concept of total pain encompasses a person's physical, psychological, social, spiritual, and practical struggles. Effective pain and symptom management are the core elements of palliative care which aims at reducing suffering and improving quality of life (QOL) throughout the course of illness and need to be addressed with multidisciplinary coordinated approach in a timely manner. It may be challenging for palliative care providers to address all these distressing issues during short out-patient consultations. Hence, Respite Palliative Care Unit (RPCU) is an appropriate place to provide holistic patient care.
A 59-year-old widow, from Muslim community, was following up with Palliative Medicine out-patient department for management of progressively increasing chest pain with frequent exacerbations. She remained unsatisfied with the pain management and reported moderate to severe intensity of pain despite maximal pain management using multimodal approaches. We planned to systematically explore and address the issues leading to uncontrolled pain and distress. The patient was admitted to RPCU for holistic pain management and continuity of care. We explored and addressed the complex psycho-socio-spiritual aspects contributing to the total pain experience to achieve better symptom control and improve her overall well-being.
This case report emphasizes the role of RPCU in effective and holistic management of psychosocial, spiritual issues, difficult communication, and advanced care planning. This model of palliative care can be a valuable addition to various health-care set-ups in the developing countries for improvement of patient care.
整体疼痛的概念涵盖了一个人的身体、心理、社会、精神和实际方面的挣扎。有效的疼痛和症状管理是姑息治疗的核心要素，其旨在在疾病全过程中减轻痛苦并提高生活质量（QOL），需要通过多学科协调方法及时加以解决。对于姑息治疗提供者而言，在简短的门诊会诊期间解决所有这些令人痛苦的问题可能具有挑战性。因此，暂托姑息治疗单元（RPCU）是提供全面患者护理的合适场所。
一名来自穆斯林社区的59岁寡妇，因进行性加重且频繁发作的胸痛，在姑息医学门诊接受随访。尽管采用多模式方法进行了最大程度的疼痛管理，但她对疼痛管理仍不满意，并报告疼痛强度为中度至重度。我们计划系统地探索并解决导致疼痛和痛苦无法控制的问题。该患者被收治入RPCU进行全面的疼痛管理和持续护理。我们探索并解决了导致整体疼痛体验的复杂心理-社会-精神方面的问题，以实现更好的症状控制并改善她的整体健康状况。
本病例报告强调了RPCU在有效和全面管理心理社会、精神问题、沟通困难及高级护理计划方面的作用。这种姑息治疗模式可为发展中国家的各种医疗保健机构增添宝贵内容，以改善患者护理。
