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BASIC PRINCIPLES

IN
PALLIATIVE CARE
Jephin Thomas Philip
11AR08
Tamilnadu School of Architecture

JEPHIN THOMAS PHILIP

WHY WE NEED
PALLIATIVE CARE?
oInappropriate communication between physician and patient and
family.
oinappropriate pain control.
oLoad of symptoms in the end of life .
oMajority of diagnosed patient are in late stage .

JEPHIN THOMAS PHILIP

SYMPTOMS AT THE END OF LIFE:


CANCER VS. OTHER CAUSES OF DEATH
Cancer

Pain 84% 67%


Trouble breathing 47%
Nausea and vomiting51% 27%
Sleeplessness 51% 36%
Confusion 33% 38%
Depression 38% 36%
Loss of appetite 71% 38%
Constipation 47% 32%
Bedsores 28% 14%
Incontinence 37% 33%

Others
49%

Seale and Cartwright, 2012


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NEW CONCEPT
oTHE TERMINALLY PATIENT.
oSHIFTING THE GOAL OF THE TREATMENT.
oGOOD DEATH.
oCOMFORT AND SUFFERING.
oTRUTH TELLING.
oQUALITY OF LIFE
oTHE PLACE OF THE DEATH.

JEPHIN THOMAS PHILIP

PALLIATIVE CARE
Treatment 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 PHILIP

PRINCIPLES
oprovides relief from pain and other distressing symptoms;
oaffirms life and regards dying as a normal process;
ointends neither to hasten nor postpone death;
ointegrates the psychological and spiritual aspects of patient care;
ooffers a support system to help patients live as actively as possible until death;
ooffers a support system to help the family cope during the patients illness and in their own bereavement;
odistressing clinical complications.

JEPHIN THOMAS PHILIP

PRINCIPLES
ouses a team approach to address the needs of patients and their families, including bereavement
counseling, if indicated;
owill enhance quality of life, and may also positively influence the course of illness;
ois 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 PHILIP

CHEMOTHERAPY
Chemotherapy 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
children
These 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 PHILIP

OLD MODEL OF CARE


ABRUPT TRANSITION TO HOSPICE
D
I
A
G
N
O
S
I
S

CURATIVE

PALLIATIVE
D
D
D
E

PROLONGATION
OF
LIFE

RELIEF OF
SUFFERING

A
T
H

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MODERN MODEL OF CARE

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Most Recent MODEL OF


CARE
Continuum of Care

Curative Treatment
(Cancer, CHF, COPD, AIDS,
Dementia debilitating
Neurological diseases )

Hospice

Bereavement Care

Palliative Treatment
Diagnosis

Death

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CURE VS. PALLIATION


Cure
fundamental hope is eradication of disease
assumes cure is worth a sacrifice

Palliation
fundamental hope is comfort
consequences of any intervention that relieves suffering are acceptable

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HOW COULD WE ASSESS THE


PATIENT NEEDS?
Physical.
Psychological.
Spiritual.
Social.

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THE PROCESS OF DYING


The following signs show that a person with cancer is entering the final weeks of life:
Progressive weakness and exhaustion
Needing to sleep much of the time, often spending most of the day in bed or
resting
Weight loss and muscle wasting
Loss of appetite and difficulty eating or swallowing fluids
Decreased ability to talk and to concentrate
Loss of interest in things that were previously important
Loss 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.

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PHYSICAL DIMENSION
Performance status (ADL).
Symptoms.
Nutrition and hydration.
Physical safety (falls).

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PSYCHOLOGICAL DIMENSION
Emotions .
Cognition .
Mood.
Coping style.
Fears.
Dreams that shattered.
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THE INTERDISCIPLINARY
TEAM
Physicians .
Nurses .
Social worker.
Physiotherapist .
Volunteers .
clinical psychologist .
secretary .
Clergyman.
Pharmacist
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BARRIERS IN PALLIATIVE
CARE
oDelays in the decision making .
oif it's possible to discuss? (about shifting goals of treatment).
oSocial and cultural issues.
oNot enough palliative care services.
oIndeed, 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.
oMorphine 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.
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BARRIERS IN PALLIATIVE
CARE
oTrust between staff and family.
oPatient and family education (other caregivers).
o Education and training of palliative care for medical staff,
particularly physicians and nurses is not available.

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THE 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

Education
Public Health care professionals
(doctors, nurses, pharmacists)
Others (healthcare
policymakers / administrators,
drug regulators

Changes in health care regulations /legislation


to improve drug availability (especially opioids)
Improvements in the area of prescribing,
distributing, dispensing, and administration of
drugs

All three should be done namely:

Governmental policy
National 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 ill
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NEED OF HOSPICE CARE IN


INDIA?
Palliative cares in India:
STATES

Kerala
Tamilnadu
Karnataka
Delhi
Maharashtr
a
Andhra
Pradesh
Assam
Uttar
Pradesh
West
Bengal
Rajasthan
Punjab
Orissa

187
13
5
4
3
2
2
2
2
1
1
1
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STATISTICS
Cause of death 2013
Heart 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 Health
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STATISTICS
Distribution of Mortality Rates by Age Group

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