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PCC4U Core Module 3: Assessing and managing symptoms provides detailed information about assessment to determine a person and their family's physical, emotional, social, cultural and spiritual needs. Management of symptoms in palliative care is focused on providing comfort and supporting the best possible quality of life.

Common symptoms that people can experience include:

Pain

Breathlessness

Fatigue

Nutrition and hydration problems

Delirium and confusion.

Medication

For many Aboriginal and/or Torres Strait Islander people, the end-of-life journey is an important spiritual time; their focus may be on passing on cultural knowledge to family and community members. There is often a desire to stay alert in order to spend time with people, especially as many people - family, friends and community members - are visiting to pay their respects.

For this reason, there can be a reluctance to take strong analgesics, such as morphine (which is often used to manage pain and breathlessness) due to the possible side-effects of becoming tired, drowsy or confused. Concerns about becoming addicted to pain medications can also be common.

Information to help Aboriginal and/or Torres Strait Islander people understand morphine, and how and when it is used, is important to provide. For example: Understanding morphine - Cancer Council Qld ¹

It is important for healthcare professionals to be aware of possible nonverbal signs of distress and pain as this might not always be communicated verbally by Aboriginal and Torres Strait Islander peoples. There can be a reluctance to ask for help, fearing that they would be "too much trouble" for staff. They may also be worried about sharing personal information with staff. IPEPA Cultural Considerations

Asking direct, open-ended questions, and giving the person time to answer can be helpful, such as:

It looks to me like you're in pain. Tell me about the pain?

You seem worried. What's worrying you?

Is there anything you're worried about at the moment?

Key Video Resource: Tom's Story (Part 2) with expert commentary (6:09)

In this PCC4U Case Scenario video, the story of Tom and his family continues. Sarah and Nancy go to see Tom together. They talk about using morphine to help manage Tom's symptoms. Tom and his family talk about what is important to them.

Check the thinking points below for some questions to consider with regard to this video.

The multidisciplinary team

Many different members of the healthcare team are involved in providing palliative care for Australian Indigenous peoples. These include palliative care specialists, general practitioners and other medical specialists, nurses, care workers, and allied health professionals, such as physiotherapists, occupational therapists, social workers, psychologists, pharmacists, paramedics and speech pathologists.

Traditional healers (also called Ngangkari or Maparn) may also be involved in the care of some Aboriginal and/or Torres Strait Islander people. More information about traditional healing is included in Activity 16.

Traditional language interpreters, working with the family spokesperson, may also be involved in providing care, particularly with supporting advance care planning conversations.

Local support networks that the person and family are already connected with in their community, such as an Aboriginal Medical Service or Community Controlled Health Service, will also be involved in providing palliative care. Maintaining open communication with all the various members of the healthcare team is an important part of ensuring continuity of care for people, especially across transitions of care - between home / community care, hospital and/or residential care facility.

Aboriginal and/or Torres Strait Islander health professionals

If available, the services and support Aboriginal and/or Torres Strait Islander health workers and practitioners should be offered in providing palliative care. They play a vital role in helping people navigate the healthcare system, providing cultural brokerage and supporting family liaison. These professions are integral to the delivery of culturally-safe and responsive care. They can play an important role in helping to ensure cultural considerations are incorporated into care, particularly at end of life.

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PCC4U Core Module 3: Assessing and managing symptoms provides detailed information about assessment to determine a person and their family's physical, emotional, social, cultural and spiritual needs. Management of symptoms in palliative care is focused on providing comfort and supporting the best possible quality of life.

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To refresh your understanding of assessment and management of symptoms in palliative care, refer to Core Module 3

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To refresh your understanding of assessment and management of symptoms in palliative care, refer to Core Module 3

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MODULE 3: Assessing and managing symptoms Archives - PCC4U

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Palliative Care Curriculum for Undergraduates

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Write down the explanations you would use as well as other communication techniques that demonstrate respect and support the person to feel culturally-safe.

Add a comment below with your thoughts...

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It is helpful to provide information to help Aboriginal and/or Torres Strait Islander people understand morphine, and how and when it is used.

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Reflect on how you would approach a conversation about using morphine for pain and symptom management in a situation like this where there was an obvious reluctance.

Add a comment below with your thoughts...

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In this PCC4U Case Scenario video, the story of Tom and his family continues. Sarah and Nancy go to see Tom together. They talk about using morphine to help manage Tom’s symptoms. Tom and his family talk about what is important to them.

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For many Aboriginal and/or Torres Strait Islander people, the end-of-life journey is an important spiritual time; their focus may be on passing on cultural knowledge to family and community members. There is often a desire to stay alert in order to spend time with people, especially as many people – family, friends and community members – are visiting to pay their respects.

For this reason, there can be a reluctance to take strong analgesics, such as morphine (which is often used to manage pain and breathlessness) due to the possible side-effects of becoming tired, drowsy or confused. Concerns about becoming addicted to pain medications can also be common.

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This activity is an excerpt from the PCC4U Focus Topic 2 Toolkit and specifically looks at using medication for symptom management in palliative care for Australian Indigenous peoples.