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Soulful Departures: Exploring collaborative approaches in end-of-life support

Introduction

Soul Departures works within hospices, palliative care facilities or at individuals’ homes to ensure that, while managing pain and other symptoms, people have an experience that is as serene as possible with the highest level of quality of life. The focus is on providing a holistic protocol that is tailored to an individual’s specific needs (at the psychological, physical, social and spiritual level). 

This blog article explores the difference between home, hospice, and palliative care and investigates who composes the ideal end of life team and what type of interventions a person can expect from the team in the last hours of life. Lastly, I will consider the importance of communication in the collaborative efforts of the end-of-life team and how a doula is at the cornerstone of the smooth transition between professionals involved.

Home care, Hospice Care and Palliative Care

End-of-life care can be provided in various settings such as hospitals with dedicated palliative care units or hospice facilities specially designed for end-of-life support. In some cases, it may also be offered in the patient’s home through home-based palliative services. Home-based palliative services is the area of focus of Soul Departures. But regardless of the setting, end-of-life care aims to create an environment where patients feel valued, respected, and supported throughout their journey. At home, hospice or in the hospital setting a doula can provide the individualized attention that is often difficult to get in the Canadian health care system that continues to have shortages and limitations.

It is important to distinguish between hospice care and palliative care as they offer distinct services tailored for different stages of an individual’s illness journey. Hospice care provides specialized support for individuals with terminal illnesses whose life expectancy is six months or less if the disease follows its usual course. In British-Columbia, because of how resources are allocated, a patient is usually admissible to hospice with a life expectancy of 3 months or less. Hospice care offers essential end-of-life services focused on comfort rather than curative treatment. On the other hand, palliative care is an interdisciplinary approach aimed at alleviating suffering at any stage of a serious illness. It can be provided alongside curative treatments for patients dealing with advanced cancer or other life-limiting illnesses.

The multidisciplinary team collaborating in end-of-life care

End of life care involves a multidisciplinary team, including physicians, nurses, care aids, physical therapists, social workers, pharmacists, nutritionists, and end-of-life doulas. This collaborative approach ensures that all aspects of a patient’s care, including the physical, psychological, social, and spiritual, are adequately addressed. Death doulas can work with physicians and nurses to implement a comprehensive personalized care plan that reflects the client’s needs, wishes, and values.

Collaboratively with the other members of the end-of-life team, death doulas can also educate the patient and their loved ones about the departing process, helping them understand what to expect and providing support for emotional or spiritual concerns that may arise. By combining their unique skills and perspectives the end-of-life care team can then create a supportive, and comforting environment that honors the patient’s wishes and ensures a dignified and peaceful transition at the end of life.

Different types of interventions in the last hours of physical life

End-of-life care focuses on effective symptom management by employing a combination of medications and non-pharmacological interventions tailored to each patient’s specific needs. It is important to plan and secure access to all the necessary interventions to optimize comfort and quality of life. Soul Departures facilitates and supports the booking, scheduling, and planning process with an emphasis on holistically supporting the natural process of departing.

Non-Pharmacological Interventions:

  • Psychosocial Support:Death Doula can provide space to process the emotional impact of the illness by giving support through talk therapy and visualization. We also offer emotional support not only to the patient but also to the patient’s loved ones, helping them navigate the complex emotions associated with the end-of-life process.
  • Physical Therapy:Improving overall physical functioning and ergonomic comfort, and thus enhancing the patient’s quality of life.
  • Nutritional Support:Ensuring that patients receive proper nutrition through dietary management or, if necessary, using feeding tubes or intravenous nutrition.
  • Complementary Therapies:Offering complementary treatments like massage therapy, therapeutic touch, reiki, acupuncture, or relaxation techniques to alleviate physical symptoms like pain and promote a sense of well-being.
  • Spiritual and Existential Support:Soul Departures provides spiritual and existential support for people going through a health challenge and their loved ones. We offer a space that reflects one’s beliefs where it is possible to find meaning (e.g. personalized rituals), sacredness, purpose, and comfort.

Pharmacological Interventions:

  • Pain Management:Medications such as opioids (e.g., morphine, fentanyl), nonsteroidal anti-inflammatory drugs (NSAIDs), and adjuvant analgesics (e.g., gabapentin, amitriptyline) may be used to manage pain effectively.
  • Symptom-Specific Medications:Drugs may be administered to address specific symptoms such as nausea (antiemetics), constipation (laxatives), or shortness of breath (bronchodilators, opioids).
  • Psychological Distress:Medications like antidepressants, anxiolytics, or antipsychotics might be prescribed to alleviate psychological symptoms like depression, anxiety, or delirium.

Holistic care is the care Soul Departures supports by collaborating with other professionals and coordinating various pharmacological and non-pharmacological interventions.

The Importance of communication in a collaborative approach

End-of-life care requires delicate conversations that are honest, direct but still compassionate and sensitive. By fostering and supporting open lines of communication, death doulas facilitate an environment where stress is minimized.

In our challenged health care system, health care professionals often don’t have the appropriate time available to prepare a patient for a difficult decision-making process. For example, there is limited space to discuss treatment options, the prognosis of the life-limiting illness, to explore advance care planning, project a plan for pain control, or address in depth other aspects related to terminal illness care. A death doula can provide the adequate space for the patient and his/her care network to voice things out prior to an appointment. Creating a safe space to express all doubt, fear, anxiety, desires. A space where clarity and peace can unfold.

Questions where a doula can guide with empathy and without judgement are for example: does a person want to transition while being able to be present and aware, or does a person prefer to be sedated? What type of environment is wished for as the departure journey unfolds? These questions can be explored in depth and at length, so a person’s wish and values are truly respected and embodied. These conversations take place within a space where there is empathy and no judgement.

Having these questions explored leads to clearer conversations with the medical staff and help make informed decisions about a care plan that can truly reflect one’s wished experience. It also enables families or care networks to have more clarity so they can provide appropriate support with minimum stress.

Conclusion

Soul Departures advocates for a collaborative and holistic approach to end-of-life care, leaning on my background in religious studies, law and holistic health, I emphasize the importance of tailored support that goes beyond conventional medical interventions that can be adapted to various settings, home, hospice, or palliative care units.

We curate an environment where people can navigate their departing journeys with dignity and clarity. The departing journey is a collaborative effort, with physicians, nurses, care aids, physical therapists, social workers, pharmacists, nutritionists, where we can all ensure that the—physical, psychological, social, and spiritual—wellbeing are considered and addressed. Effective communication emerges as a cornerstone in the collaborative efforts of the end-of-life team. In a healthcare system often constrained by time and resources, death doulas play a crucial role in providing the necessary space for clear, open, and deep conversations and for a deeper level of care and attention that the dying process requires. Through the orchestration of a multidisciplinary team Soul Departures strives, to ensure that the final chapter of life is characterized by comfort, clarity, peace, sacredness and meaning.

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