Palliative Care Of Palliative Care Of the Dying Womanthe Dying Woman

ObjectivesObjectives

• Describe the Philosophy of Palliative Describe the Philosophy of Palliative CareCare

• Discuss the emotionsDiscuss the emotions• Discuss how a women's terminal Discuss how a women's terminal

diagnosis may affect her familydiagnosis may affect her family• Examples that contribute or detract Examples that contribute or detract

from a good deathfrom a good death

Women's Funeral of 1901Women's Funeral of 1901

What is palliative Care?What is palliative Care?

CHPCA ModelCHPCA Model

Time

Congestive

Heart Failure

Colon Cancer

deathDeath unpredictable -No clear decline phase

Clear phase ofdecline - allowshospice referral

Illness Impact Trajectory*

Time

Congestive

Heart Failure

Colon Cancer

deathDeath unpredictable -No clear decline phase

Clear phase ofdecline - allowshospice referral

Illness Impact Trajectory*

Time

Func

tiona

l Dis

abili

ty o

r Se

veri

tyof

Illn

ess

Congestive

Heart Failure

Colon Cancer

deathDeath unpredictable -No clear decline phase

Clear phase ofdecline - allowshospice referral

Illness Impact Trajectory*

Time

Func

tiona

l Dis

abili

ty o

r Se

veri

tyof

Illn

ess

Congestive

Heart Failure

Colon Cancer

deathDeath unpredictable -No clear decline phase

Clear phase ofdecline - allowshospice referral

Illness Impact Trajectory*

Palliative Care…Palliative Care…

• Focuses on relieving suffering, Focuses on relieving suffering, improving quality of lifeimproving quality of life– Affirms life, sees death as a personal and Affirms life, sees death as a personal and

natural processnatural process– Many diagnosesMany diagnoses– Appropriate early in course of illnessAppropriate early in course of illness– Patient and family preferences respectedPatient and family preferences respected– May be combined with curative May be combined with curative

therapies or may be the focus of caretherapies or may be the focus of care

……Palliative CarePalliative Care

• Interdisciplinary care of the patient Interdisciplinary care of the patient and familyand family

• Pain and symptom management Pain and symptom management • May include disease-modifying May include disease-modifying

treatmentstreatments• Psychological, social, spiritual Psychological, social, spiritual

supportsupport• Bereavement supportBereavement support

Essence of palliative care – Essence of palliative care – A personal reflectionA personal reflection

• Improving the Quality of life is the total approachImproving the Quality of life is the total approach• Relieving total sufferingRelieving total suffering• The intersection of biology and biographyThe intersection of biology and biography• Making people matterMaking people matter• Having the courage to be inspired and then to actHaving the courage to be inspired and then to act• Meeting the needs of the patient and their Meeting the needs of the patient and their

caregiverscaregivers• Care and compassionCare and compassion• Goals of careGoals of care

Shock:Shock:• Denial vs. PanicDenial vs. Panic

Emotion: Emotion:

• Catharsis vs. DepressionCatharsis vs. Depression

Negotiation:Negotiation:• bargaining vs. selling outbargaining vs. selling out

Cognition:Cognition:• Realistic Hope vs. DespairRealistic Hope vs. Despair

Commitment:Commitment:

•Acceptance vs. ResignationAcceptance vs. Resignation

Completion:Completion:• Fulfillment vs. ForlornnessFulfillment vs. Forlornness

• Fear : The fear of my own undoingFear : The fear of my own undoing

IntimacyIntimacy

• Guilt : families anger toward the Guilt : families anger toward the dying persondying person

: need to review what has : need to review what has happened or happened or what was what was neglectedneglected

• Anxiety: Tolstoy- The Death of Ivan Anxiety: Tolstoy- The Death of Ivan IlychIlych

Death anxietyDeath anxiety

Good Death: Bad DeathGood Death: Bad Death

• Is there such a thing?Is there such a thing?

• Open, ongoing Open, ongoing communicationcommunication

• Preservation of Preservation of the patient’s the patient’s decision-making decision-making powerpower

•

SophisticateSophisticatedd

Symptom Symptom controlcontrol

• Limits are set Limits are set on excessive on excessive treatmenttreatment

• A focus on A focus on preserving patient preserving patient quality of lifequality of life

• Emotional Emotional supportsupport

• Spiritual Spiritual supportsupport

• The patient is not The patient is not abandoned by abandoned by medical staff even medical staff even when curative when curative treatment is no treatment is no longer required.longer required.

The dying need the friendship of the The dying need the friendship of the heart – its qualities of care, heart – its qualities of care,

acceptance, vulnerability; but they acceptance, vulnerability; but they also need the skills of the mind- the also need the skills of the mind- the most sophisticated treatment that most sophisticated treatment that

medicine can offer. On its own, medicine can offer. On its own, neither is enoughneither is enough

Dame Cicely Dame Cicely SaundersSaunders

Thank you for your kind Thank you for your kind attention.attention.

Questions?Questions?