Introduction to Palliative Care

Dr Tan Chai EngDepartment of Family Medicine, UKM

10/9/2014

Pre-lecture activity (5 mins)

• What do you understand about palliative care?

• Write or draw your answer

• Label it as ‘pre-lecture’

• Keep it with you until the end of the lecture

Why do I need to learn this?

Short videos

• Life before Death:

– What is palliative care?

– Care beyond cure?

What is “Palliative Care”?

• Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

http://www.who.int/cancer/palliative/definition/en/

Why “Palliative Care”?

• Access to palliative care is a human right.

• Great need, limited resources

• Even healthcare professionals may have limited awareness or knowledge of palliative care!

Myths and misconceptions

• Palliative care is only for those who are dying

• Palliative care is only for those who have no chance for cure

• Palliative care means giving up hope

• Patients who choose palliative care die faster

• Pain relief from palliative care creates addiction

http://medhealthwriter.com/palliative-care/top-10-myths-of-palliative-care/

What would you choose if you had a life-limiting illness?

• Why do doctors die differently? Ken Murray, 2011

Gallo, 2003

So, what actually does palliative care do?

• Recognising symptoms such as pain, nausea, fatigue, breathing or swallowing difficulties, constipation, and hopelessness.

• Identifying the patient's goals and needs so a palliative care plan can be developed specially for the patient.

• Understanding that many patients and their families struggle to make decisions. We help to facilitate difficult conversations between all parties so that trust can be established and relationships strengthened.

• Assisting with advanced care directives to help people formulate and communicate their preferences regarding care during future incapacity. It must be understood, however, that euthanasia cannot be accepted as part of palliative care.

http://www.palliativecare.my/about

Palliative care provides relief from pain and other distressing symptoms

Pain is not just physical…

Physical Psychological

Social Spiritual

Total Pain

Common symptoms in palliative care

Palliative care affirms life and regards death as a normal process

I am not afraid of death, but I am afraid of suffering…

Palliative care intends neither to hasten or postpone death

• Treatment aims not for cure, not for prolonging life

• Treatment aims to reduce suffering

Palliative care integrates the psychological and spiritual aspects of

patient care

Family conference,

welfare referrals

Pastoral care

Appropriate use of

analgesics, symptom relief

Antidepressants, supportive

psychotherapy, CBT

Palliative care offers a support system to help patients live as actively as

possible until death

Katie Kirkpatrick 2005 http://www.weddinggirl.ca/blog/weddingthemes/wedding-cancer-story/

Hospis Malaysia, OT

Palliative care offers a support system to help the family cope during the patients’

illness and in their own bereavement

Palliative care uses a team approach to address the needs of patients and

their families• Multi-disciplinary care to

provide comprehensive care for patients

Palliative care will enhance quality of life, and may also positively influence the course of illness

• Stories and testimonies of patients and their families who received palliative care at http://www.palliativecare.my/testimonials

Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to

prolong life

Needs of palliative

care patients

Physical

Psychological

Financial & legal

Spiritual concerns

Information

Social support

What is needed?

Multidisciplinary approach

Good clinical assessment

Judicious use of investigations

Fulfill information

needs

Facilitate decision making

Communication skills

Psychosocial problems

Care for caregivers

Pain management

Other common symptoms Common symptoms Possible pharmacological treatment

Nausea and vomiting Metoclopramide, prochlorperazine, haloperidol, granisetron

Dyspnoea, cough Morphine, codeine, prednisolone,salbutamol

Anorexia, cachexia Treating is controversial. Steroids, medroxyprogesterone, megestrol

Fatigue

Constipation Bisacodyl, senna, lactulose, enemas

Diarrhoea Loperamide, Lomotil, codeine

Other common symptoms

Common symptoms Possible pharmacologicaltreatment

Intestinal obstruction Haloperidol, hyoscine, octreotide

Depression SSRI, benzodiazepines

Malignant ulcers (foul odour) Metronidazole tablets

Minor bleeding Tranexamic acid

Oral health issues Oral hygiene, xylocaineviscous, bonjela

Non-pharmacological

• Physiotherapy

• Occupational therapy

• Massage

• Music

Community Palliative Care

• Available mainly in urban areas

• Delivered by palliative care nurses and doctors, other allied health professionals

• Allows patients to die at home

• Provides nursing and medical care, symptom control, information, practical advice, equipment loan, carer support, preparation for death

Community Palliative Care

• Shared care with primary clinician

• GPs can play a major role in areas with no community palliative care services

http://www.palliativecare.my/

Types of palliative care

Palliative medicine

General palliative care

Palliative care approach

All healthcare professionals!

Additional training

Specialised settings, hospice

Post-lecture activity (5 mins)

• Write down / draw a picture to explain what palliative care means to you now.

• Label it “after lecture”

• Compare it with your first picture

• Has it changed?

Reflections

• Write a short paragraph on what palliative care means to you. Submit to Dr Tan’s pigeonhole at Department of Family Medicine, 14th floor, Preclinical Block, UKMMC.

For your reading pleasure…

THANK YOU