Enhancing Quality of Life Through Therapeutic Monitoring

The primary goal of medication therapy is to treat diseases or alleviate symptoms, but in palliative care, the emphasis shifts to relieving distressing symptoms and improving patients' quality of life. This shift necessitates a careful evaluation of the benefits and potential risks associated with medication, particularly for vulnerable patient groups, including those in palliative care.

Palliative patients often suffer from incurable conditions such as advanced cancer or serious internal diseases with limited life expectancy. These patients frequently belong to older age groups and may experience multiple health issues, compounded by organ failures. Common symptoms include pain, shortness of breath, nausea, anxiety, and restlessness.

To ensure effective and safe treatment, individualized monitoring of medication therapy becomes crucial in the care process. This approach allows for the best possible alignment of treatment with patient needs and facilitates adjustments when medications are ineffective or cause burdensome side effects, all while considering the patient's unique circumstances.

However, therapeutic monitoring in palliative contexts presents specific challenges. Multiple factors influence therapy planning and supervision, including medical aspects, patient preferences, and the resources available in the care environment.

The focus of palliative care is to enhance the quality of life for both patients and their families. Symptom relief is a primary objective, encompassing physical, psychosocial, and spiritual dimensions. Another critical aspect is the personalized treatment of patients, which includes considerations for both the type of care and the setting. General palliative care is often provided by hospice organizations, general practitioners, and outpatient nursing services. In contrast, specialized palliative care occurs in inpatient settings like palliative wards and hospices, with specialized outpatient palliative care teams playing a significant role in home care.

Typically, palliative patients may be prescribed numerous medications, sometimes up to 15 different types. Nearly half of these medications are used off-label, increasing the risk of adverse drug reactions. Furthermore, patients may also take over-the-counter medications and supplements on their own initiative, further complicating their treatment.

As the number of medications increases, so does the risk of severe adverse effects. Organ insufficiencies can alter the metabolism and elimination of drugs, leading to diminished or heightened effects, which may worsen the patient's condition or lead to unnecessary hospitalizations.

One useful tool for assessing symptom burden in palliative care is the Integrated Palliative Care Outcome Scale (IPOS). This scale helps capture the current needs and challenges faced by patients, focusing not on the severity of symptoms but on their impact on patients' lives. Patients indicate on a scale from 'not at all' to 'extremely' how distressing symptoms like pain, shortness of breath, weakness, nausea, or dry mouth are for them.

This approach facilitates the establishment of clear therapeutic goals, the evaluation of intervention outcomes, and the tracking of treatment progress. Additionally, it allows for the prioritization of the most distressing symptoms.

In conclusion, effective therapeutic monitoring plays a pivotal role in enhancing the quality of life for palliative patients. By aligning treatment closely with individual needs and systematically addressing symptoms, healthcare professionals can significantly improve the well-being of those in palliative care.