Question

Discuss student views regarding the shift from curative care to treatment of chronic conditions and the effects of this transition on patients and caregivers alike.

Answer 1

Descriptions of chronic disease and chronic illness

Chronic disease: has various definitions: “long in duration—often with a long latency period and protracted clinical course; of multi-factorial aetiology; with no definite cure; gradual changes over time, asynchronous evolution and heterogeneity in population susceptibility.Diseases referred to as chronic include both non-communicable diseases, such as diabetes, heart disease, chronic obstructive pulmonary disease, cancer, and depression, and communicable diseases, such as AIDS.Chronic disease refers to a diagnosis categorized in the biomedical system according to etiology, pathophysiology, signs, symptoms, and treatment that also implies an expected long duration and lack of cure.Conditions, syndromes, and disorders are similar, but are less well-defined.

Chronic illness:refers to the lived experience of long-term bodily or health disturbance. whether related to a communicable or non-communicable disease, condition, syndrome, or disorder; and how people live and cope with the disruption. It is “experience of intrusive bodily or mental unwelcome unpleasant sensations” and includes phenomena such as fatigue, weakness, anomie, confusion, or social stigma

shift from curative care to treatment of chronic conditions with paliative care

Curative care

many first-line treatments for chronic disease were developed before it was understood that the death of chronic bacteria necessarily results in an immunopathological response and temporary feelings of malaise. Such treatments are designed to slow the immune response under the mistaken premise that autoimmune disease results when the immune system attacks the body.According to the Marshall Pathogenesis, bacteria drive chronic disease, and treatments that slow the immune system only appear to “work” because they decrease bacterial death. While this causes a drop in inflammation that offers temporary symptomatic relief, bacteria which drive the disease state cease to be targeted and spread easily. The net result is that patients generally become increasingly ill over the long-term.In essence, feeling better is not the same as getting better.

Treatments that target the root cause of an illness rather than masking symptoms are curative in nature. While patients taking curative treatments may not always feel better during the course of therapy, such treatments have the potential to bring about lasting recovery.Nevertheless, because palliative treatments that slow immune function are very effective at offering temporary relief, the number of medications, over-the-counter supplements, and fortified foods that work by slowing the immune response have escalated over the past decades. Since the goal of every Marshall Protocol (MP) patient is to effectively target the bacteria making them ill, such immunosuppressants must be avoided. These immunosuppressants range from corticosteroids and TNF-alpha blocking medications to “vitamin” D.

The purpose of curative care is to cure a disease or promote recovery from an illness, injury or impairment.

• It can be provided in a hospital or at home.
• Services include physician and nursing care, surgery, medications and therapies.
• Two examples are chemotherapy for cancer and physical therapy after joint-replacement surgery.

The Marshall Protocol (MP) is a curative therapy and represents an alternative to therapies which mask or delay symptoms of disease. The MP aims to target the Th1 Pathogens, which we now believe are ultimately responsible for chronic inflammatory disease.

Palliative Care

Those substances that aim to cover up disease symptoms but do not succeed at reversing the disease state are palliative in nature. A variety of commonly taken medications, foods, and supplements offer temporary palliation by depressing immune function.

The purpose of palliative care is to bring comfort and relief from a serious, progressive illness that may or may not be life-limiting.

• It can be provided at home and in long-term care facilities and hospitals.
• It is available immediately after diagnosis and can be given alongside curative care.
• Services may include medical care (physician and nursing care, medications) and non-medical care (care coordination and social work).
• A personalized care plan might include, for example, pain relief medication, care coordination services and assistance with preparation of an advance directive form.

benefit from palliative care are important for

• A man in his 80s with congestive heart failure who has been hospitalized several times over the past two years
• A woman with chronic kidney disease whose doctor tells her she will need dialysis in the near future
• A cancer patient who has lost her appetite as a side effect of chemotherapy
• A woman recovering from heart surgery who has not told her family if she would like to be resuscitated to save her life again
• A man with dementia whose daughter can no longer leave him home alone safely while she runs errands
• A woman who has lived with COPD for five years and now needs her inhaler to climb stairs and do laundry

Effect of transition from curative to palliative care

Recent UK policy has stressed the importance of managing and facilitating the transition from curative care to palliative care. This review of the literature suggests that, within a UK context, little is known about this potentially complex transition, and literature relating to the optimisation of the transition is sparse. As such, the review attempts to identify important issues for the conceptualisation and optimisation of transitions to palliative care. It is clear that such transitions can be a confusing and distressing time for patients and their families. They can leave patients and their families feeling abandoned and lacking a clear understanding of their future care and treatment options. Facilitating a sensitive transition is therefore imperative for improving the experiences of patients and their families at this difficult time.

A phased transition incorporating palliative care in parallel with disease-modifying treatments appears the most appropriate model for optimising transitions. This model is particularly relevant for patients with non-cancer disease, whose condition may be more slowly progressive, or with fluctuating trajectories. Within this phased transition, continuity of care and multidisciplinary collaboration are crucial. An agreed consensus of definition, and potential refinements to the concept of ‘transition’, may also be necessary to enhance consistency.