Basic Principles in Palliative Care

Basic PrinciplesinPalliative CareJephin Thomas Philip11AR08Tamilnadu School of ArchitectureJEPHIN THOMAS PHILIP1Why we need palliative care?Inappropriate communication between physician and patient and family.inappropriate pain control.Load of symptoms in the end of life .Majority of diagnosed patient are in late stage .

JEPHIN THOMAS PHILIP2Symptoms at the End of Life: Cancer vs. Other Causes of Death Cancer OthersPain84%67%Trouble breathing 47% 49% Nausea and vomiting51%27%Sleeplessness51%36%Confusion33%38%Depression38%36%Loss of appetite71%38%Constipation47%32%Bedsores28%14%Incontinence37%33% Seale and Cartwright, 2012JEPHIN THOMAS PHILIP33BASIC PRINCIPLES OF HOSPICE CARENew concept THE TERMINALLY PATIENT.SHIFTING THE GOAL OF THE TREATMENT.GOOD DEATH.COMFORT AND SUFFERING.TRUTH TELLING.QUALITY OF LIFETHE PLACE OF THE DEATH.

JEPHIN THOMAS PHILIP4Palliative careTreatment approach that improves quality of life of patient and their family members, that deal to the diseases that threaten on life, by prevention and alleviation of the suffering by means of early detection and professional estimation of pain and additional symptoms, bodily psychosocial and spiritual.

(WHO 2002) JEPHIN THOMAS PHILIP5PRINCIPLESprovides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten nor postpone death; integrates the psychological and spiritual aspects of patient care;offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement; distressing clinical complications.

JEPHIN THOMAS PHILIP6PRINCIPLESuses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, JEPHIN THOMAS PHILIP7ChemotherapyChemotherapy is a method of treating cancer by using one drug or a combination of drugs. These powerful drugs work by slowing or stopping the cancer cells from growing, spreading or multiplying to other parts of the body.Treats whole body at once, unlike targeted treatments such as radiation, so whole body feels the effects of treatment. Is usually given on an outpatient basis, but may involve hospital stay for young childrenThese drugs can damage healthy cells and the immune system in addition to cancerous cells. This can cause many side effects such as: appetite/weight loss, hair loss, nausea and vomiting, fatigue, memory loss, flu-like symptoms and aches, mouth sores, constipation or diarrhea, difficulty swallowing, kidney/urinary tract or bladder infections, etc.

JEPHIN THOMAS PHILIP8OLD MODEL OF CARE CURATIVE PROLONGATION OF LIFEDIAGNOSIS PALLIATIVERELIEF OF SUFFERINGDDABRUPT TRANSITION TO HOSPICEDEATHJEPHIN THOMAS PHILIP9MODERN MODEL OF CARE

JEPHIN THOMAS PHILIP10Curative Treatment(Cancer, CHF, COPD, AIDS, Dementia debilitating Neurological diseases )Palliative TreatmentBereavement CareHospiceDeathDiagnosisMost Recent MODEL OF CAREContinuum of CareJEPHIN THOMAS PHILIP111111BASIC PRINCIPLES OF HOSPICE CARECure vs. PalliationCurefundamental hope is eradication of disease assumes cure is worth a sacrifice

Palliationfundamental hope is comfortconsequences of any intervention that relieves suffering are acceptable

JEPHIN THOMAS PHILIP12How could we assess the patient needs? Physical. Psychological. Spiritual. Social.JEPHIN THOMAS PHILIP13The Process of DyingThe following signs show that a person with cancer is entering the final weeks of life:

Progressive weakness and exhaustionNeeding to sleep much of the time, often spending most of the day in bed or restingWeight loss and muscle wastingLoss of appetite and difficulty eating or swallowing fluidsDecreased ability to talk and to concentrateLoss of interest in things that were previously importantLoss of interest in the outside world and wanting only a few people nearby. The person with cancer may want only a few people to visit, or may need to limit the time spent with visitors.JEPHIN THOMAS PHILIP14Physical Dimension Performance status (ADL).

Symptoms.

Nutrition and hydration.

Physical safety (falls).JEPHIN THOMAS PHILIP15Psychological DimensionEmotions .

Cognition .

Mood.

Coping style.

Fears.

Dreams that shattered. JEPHIN THOMAS PHILIP16The Interdisciplinary TeamPhysicians .Nurses .Social worker.Physiotherapist .Volunteers . clinical psychologist .secretary .Clergyman.Pharmacist JEPHIN THOMAS PHILIP17Barriers in palliative careDelays in the decision making .if it's possible to discuss? (about shifting goals of treatment).Social and cultural issues.Not enough palliative care services.Indeed, costs spent on curative efforts with minimal results would, if spent on palliative care, have a major positive impact on both patients and their families. Morphine restriction: morphine is not readily available across the country. Opioids prescription is still restricted to 3-10 days. It is recommended to be extended to a month.

JEPHIN THOMAS PHILIP18Barriers in palliative careTrust between staff and family.Patient and family education (other caregivers). Education and training of palliative care for medical staff, particularly physicians and nurses is not available.JEPHIN THOMAS PHILIP19The Triangle shaped project for establishing Palliative Care Program which was developed by WHO.Process measures: Cost little, but big effects Necessary before outcome measures Drug availability Changes in health care regulations /legislation to improve drug availability (especially opioids) Improvements in the area of prescribing, distributing, dispensing, and administration of drugs Education Public Health care professionals (doctors, nurses, pharmacists) Others (healthcare policymakers / administrators, drug regulators Governmental policyNational or state policy emphasizing the need to alleviate chronic pain through education, drug availability, and governmental support /endorsement The policy can stand alone, be part of an overall national/ state control program, be part of an overall policy on care of the terminally illAll three should be done namely:

JEPHIN THOMAS PHILIP20Need of Hospice Care in india?

STATESKerala187Tamilnadu13Karnataka5Delhi4Maharashtra3Andhra Pradesh2Assam2Uttar Pradesh2West Bengal2Rajasthan1Punjab1Orissa1Palliative cares in India:JEPHIN THOMAS PHILIP21

JEPHIN THOMAS PHILIP22StatisticsCause of death 2013Heart Diseases 20.1%Carebrovascular diseases 11.1%Perinatal conditions 9.7%Cancer 9.0%5Accidents 8.9%Hypertension 4.9%Diabetes mellitus 4.1%Renal failure 3.4%

Source: Ministry of HealthJEPHIN THOMAS PHILIP23StatisticsDistribution of Mortality Rates by Age Group

JEPHIN THOMAS PHILIP24