| Respiratory rehabilitation |
- Measures like oxygen support for relief of dyspnoea, physiotherapy, evaluation for surgery, respiratory rehabilitation including yoga, morphine for relief from respiratory insufficiency to be used.
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| Relief from pain and other symptoms |
- Paracetamol or tramadol can be used for moderate pain relief. Strong analgesics like morphine can be used when needed.
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| Infection control measures |
- Patients who are infectious need to follow infection control measures themselves, in the facility and also by caregivers.
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| Nutritional support |
- Small meals as needed are often best for a terminally ill patient.
- Nausea and vomiting or any other conditions that interfere with nutritional support should be treated.
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| Regular medical visits |
- Regular medical care of such patients is to be continued. Periodic assessment and management of post-treatment sequelae could be beneficial to the patient.
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| Vocational rehabilitation |
- Wherever possible, based on the interest of the patient, an appropriate linkage for vocational rehabilitation and new skill learning opportunities through various Non-government Organizations (NGOs) may be explored to help the patient regain his/her source of livelihood and move towards socio-economic sufficiency.
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| Continuation of ancillary drugs |
- All necessary ancillary medications should be continued as needed.
- Opioids help control cough, as well as pain. Other cough suppressants can be added.
- Bronchospasms can be controlled with a metered dosed inhaler with a spacer or mask.
- Depression and anxiety, if present, should be addressed.
- Antiemetics may still be needed, and fever treated if the patient is uncomfortable.
- Appropriate use of an alternative drug may be considered through expert consultation.
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| Preventive measures |
- Patients are encouraged to do regular movement or change position in bed to prevent bedsores.
- Overall cleanliness is to be maintained to prevent any infection.
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| Provide psychosocial support |
- Psychological counselling to the patient and family caregivers is critical at this stage, especially to assist patients in the planning of decisions related to the end-of-life stage.
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| Respect for patient’s beliefs and values |
- In such situations, patients and family members do develop more interest in spiritual and religious matters. Healthcare workers should respect the patients' spiritual and religious beliefs and should not impose their personal values.
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| Hospitalization, hospice care or nursing home care |
- Home-based or hospital-based care is to be provided to patients as per their needs and choices.
- Infection control practices to be followed.
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| Other supportive measures |
- Management of side-effects such as breathlessness, fatigue, cachexia and end-of-life crises such as haemoptysis and acute respiratory failure, besides anxiety of patients and their families, which typically accompanies these symptoms.
- When patient isolation is done, strong measures to prevent loneliness, boredom and a sense of abandonment are needed to be in place.
- These comprise daily access to family and friends under proper infection control conditions, interaction with staff and access to activities according to the patient’s condition (radio, television, hobbies, etc.).
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