Aims To explore the impact of undiagnosed alcohol dependence in palliative care patients focusing on quality of care, quality of life and potential changes to management.
Method An audit on a sample of 20 patients at Willow Wood hospice reviewing the number of patients whose alcohol intake was assessed. A review of the literature on alcohol dependence and palliative care from 1993–2013.
Results Alcohol intake is often not documented within palliative care. Only 30% of patients from a sample of 20 audited at Willow Wood Hospice were assessed on alcohol intake. Literature suggests that unknown alcohol abuse may increase the amount of opioid use in patients. Unknown alcohol withdrawal may increase the risk of terminal agitation.
Wernicke’s encephalopathy may be misdiagnosed as brain metastases in a patient with unknown alcohol dependence. Alcohol abuse in the elderly may be an under recognised problem. In small amounts alcohol may be beneficial as an analgesic, for soporific effect and to aid sleep.
Conclusion There is an already established relationship between alcohol consumption and neoplastic disease, which is a large part of palliative care. The most important factor appears to be recognising alcohol dependence and providing the appropriate psychological and medical support. This can significantly improve the patient’s quality of life: less use of opioid analgesia, less terminal agitation, better symptom control, control of withdrawal symptoms, and less psychological stress for both patient and carers.
Providing education on alcohol and drug abuse to palliative care teams, liaising with local drug and alcohol teams and ensuring alcohol intake is documented improves quality of care and confidence within the team.
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