Palliative

Care
INTRODUCTION
Palliative care is developing as an areas
of special clinical competence
throughout the world. The modern
hospice is a relatively recent concept that
originated and gained momentum in the
United kingdom after the founding of St.
Christopher‘s hospice in 1967. It was
founded by Dame Cicely Saunders, widely
regarded as the founder of modern
hospice movement.
Palliative medicine has been
recognized as a specialty in UK
since 1987, in Australia and
New Zeland since 1988. and
more recently in Canada.
Definition

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.
(WHO 2002)
Palliative care strives to help individuals
and their families: ·address physical,
psychological, social, spiritual and
practical issues and associated
expectations, needs, hopes and fears, ·
prepare for, and manage, life closure
and the dying process, and cope with
loss and grief during the illness and
bereavement.
 The National Council for Palliative Care, which is
an umbrella organisation for setting standards in
specialist palliative care in the UK, published its
current definition in 2002 NCPC definition of
palliative care
Palliative care:
• Affirms life and dying as a normal process; •
Provides relief from pain and other symptoms;
Caregiver – ―anyone who provides care.
• Care givers are people who are willing
to listen to ill persons and responds to their
individual experiences (Twycross R 2003).
• Formal caregivers are members of an
organization and accountable to defined
norms of conduct and practice. They may
be professionals, support workers, or
volunteers.
• Informal caregivers are not members
of an organization. They [usually] do
not have formal training, and are not
accountable to norms of conduct or
practice. They may be family members
or friends‖ (CPCA, 2001).
ESTIMATION • One million cases of cancer
occur each year in India, with over 80%
presenting at stage III and IV. Two thirds of
patients with cancer are incurable need
palliative care and approximately one
million people are experiencing cancer
pain every year. • Acc to WHO, more than
four million cancer patients would benefit
from palliative care. Less than one percent
of those who need palliative care services
have access to such services in India.
NEED OF PALLIATIVE CARE

Since death also affects family

members and close companions,
perhaps one to two persons giving
care and support for every one who
dies, then a conservative figure might
be 100 million people who would
benefit from the availability of basic
palliative care.
 The term "palliative care" is
increasingly used with regard to
diseases other than cancer such as
chronic, progressive pulmonary
disorders, renal disease, chronic
heart failure, HIV/AIDS, and
progressive neurological
conditions.
 Philosophy
Palliative, or comfort care, recognizes that death is a
normal part of life and strives to prepare patients and
their families so we can all die on our own terms.

From the start of a serious or terminal illness,

practitioners reduce the burden on family
caregivers by identifying and providing for the
needs of you and your family.
These needs may be physical, emotional, social
or spiritual.
 Care is Patient-Focused
Palliative cares strives to meet the physical,
psychological, spiritual and social needs of
patients and families.
It is sensitive to personal, cultural and religious
values, beliefs and practices, developmental
state,and readiness to deal with the dying
process
 Philosophy
• People Have the Right To Choice - Each person is
an autonomous and unique individual with the right
to participate in informed discussion related to care
and to choose the best possible options and
outcomes based on that information.
• Dying is Part of Life – Palliative care affirms life.
Euthanasia and physician assisted suicide are not
considered options. Palliative care never intentionally
hastens death.
• Quality of Life Guides Decisions – Care choices
should be guided by quality of life as defined by the
patient.
Palliative Care Patient Support Services

Three categories of support:

1. Pain management is vital for comfort and

to reduce patients‘ distress. Health care
professionals and families can collaborate to
identify the sources of pain and relieve them
with drugs and other forms of therapy.
Palliative Care Patient Support Services

2. Symptom management involves

treating symptoms other than pain such
as nausea, weakness, bowel and
bladder problems, mental confusion,
fatigue, and difficulty breathing
Palliative Care Patient Support Services

3. Emotional and spiritual support is

important for both the patient and family
in dealing with the emotional demands of
critical illness.
ELEMENTS OF PALLIATIVE CARE

1.PRIMARY GOAL: The primary goal is to

prevent and relieve sufferings imposed by
disease and their treatment, achievement
of best possible quality of life for patients
and their families regardless of the stage of
the disease or need for other therapies.
2.PATIENT POPULATION: Patients of all ages
experiencing a debilitating chronic or life
threatening illness, condition or injury.

3.PATIENT AND FAMILY CENTERED CARE: The

uniqueness of each patient and family is respected.
The patient family constitute the unit of care.

4.TIMING OF PALLIATIVE CARE: It ideally begins at

the time of diagnosis of a life threatening or
debilitating condition and continues through cure,
or until death and into the family‘s bereavement
period.
5.COMPREHENSIVE CARE: Palliative care employs
multidimensional assessment to identify and relieve
sufferings through the prevention or alleviation of
physical, psychological, social and spiritual distress.

6.INTERDISCIPLINARY TEAM: Team work is an integral part

of the philosophy of palliative care. Require the expertise
of various providers in order to adequately assess and
treat the complex needs of seriously ill patients and their
families.
7. COMMUNICATION SKILLS
Effective communication skills are requisite in
palliative care. These includes appropriate
and effective sharing of information, active
listening, determination of goals and
preferences, assistance with medical
decision making, and effective
communication with all individuals involved
in the care of patients and their families.
8. SKILL IN CARE OF THE DYING AND BEREAVED: Team must
be knowledgeable and skilled in providing care for the
dying and the bereaved.

9.CONTINUITY OF CARE ACROSS SETTINGS: Palliative care is

integral to all health care delivery system settings (hospital,
emergency dept, nursing homes, home care, assisted living
facilities, outpatient and non traditional environments such
as schools. The palliative care team collaborates with
professional and informal care givers in each of these
settings.
10. EQUITABLE ACCESS
Palliative care teams should work toward equitable access to
palliative care across all ages and patient populations, all
diagnostic categories, all health care settings including rural
communities, and regardless of race, ethnicity, sexual
preferences or ability to pay.

11. QUALITY IMPROVEMENT

Palliative care services are committed to the pursuit of
excellence and high quality of care which enhances the
quality of life.
Benefits of PC
• palliative approach offers many benefits to the residents, their
families and the health care team.

Some of these are:

• reducing potential distress to residents and their families caused
by a transfer to an acute care setting
• reducing the admission and/or transfer of residents to acute
care facilities as care staff develop the skills to manage the
palliative care residents
• increasing the involvement of the resident and their family in
the decision making about their care
PALLIATIVE CARE COMPETENCIES / SKILLS
• Communication skills
• Physical skills
• Psychosocial skills
• Teamwork skills
• Intrapersonal skills
• Life closure skills
Ferris FD, Bruera E, Cherny N, Cummings C, Currow D,
Dudgeon D, JanJan N, Strasser F, von Gunten CF, Von
Roenn JH. Palliative cancer care a decade later:
accomplishments, the need, next steps—from the American
Society of Clinical Oncology. Journal of Clinical Oncology.
2009 May 18;27(18):3052-8.
Thank You