Palliative Care

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Kinds of Care
 Curative Care:
Focuses on a cure to an illness and the prolonging of
life.
 Palliative Care:
Focuses on comfort and quality of life that may be
provided with other treatments.
 Hospice Care:
Focuses on comfort and quality of life when a cure is
not possible with specialize care and services.
What is Palliative Care?
 The World Health Organization describes palliative care as
"an approach that improves the quality of life of patients and
their families facing the problems associated with life-
threatening illness, through the prevention and relief of
suffering by means of early identification and treatment of
pain and other problems, physical, psychosocial and
spiritual."
WHO Definition of Palliative Care
Palliative care:
provides relief from pain and other distressing symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or 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;
WHO Definition of Palliative Care (cont.)
 offers a support system to help the family cope during the
patients illness and in their own bereavement;
 uses 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, and includes those
investigations needed to better understand and manage
distressing clinical complications.
Palliative vs. Hospice Care
 Division made between these two terms in the United States
 Hospice is a “type” of palliative care for those who are at the
end of their lives.

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http://www.ersj.org.uk/content/32/3/796.full
Who receives Palliative Care?
 Individuals struggling with various diseases

 Individuals with chronic diseases such as cancer, cardiac

disease, kidney failure, Alzheimer's, HIV/AIDS and
Amyotrophic Lateral Sclerosis (ALS)
Who Provides Palliative Care?
 Usually provided by a team of individuals
 Interdisciplinary group of professionals
 Team includes experts in multiple fields:
 Doctors
 Nurses
 social workers
 massage therapists
 Pharmacists
 Nutritionists
 Volunteers
Physicians
Nurses

Patient
Therapists and Spiritual
Counselors
Family

Home Health
Aides Social Workers

Pharmacists
 Multiple Issues Cause Suffering
Disease Management Physical Psychological
•Diagnosis •Pain, dyspnea & other •Anxiety
•Prognostication symptoms •Depression
•Management •Function, fluids, nutrition •Distress

Loss, grief Social

•Emotional responses •Family dynamics
•Bereavement •Financial
•Legal

End of life / death Practical Spiritual

management •Caregiving •Hope
•Last hours of living •Teamwork •Meaning, value
•When death occurs •Volunteers •Existential
Who is Affected
Patients & Families Want…
• Live life the way they want to
‘ Fix ’ disease, or not
Prevent and relieve suffering, or not
Don’t do treatments they don’t want

• Negotiate goals for

1. Life
2. Medical care
 What do You
want your illness
experience to be
?
Patterns of Functional Decline at
the End of Life
1 – Organ Failure 2 – Dementia

4 – Sudden
3 – Cancer
Death

Lunney JR et al. JAMA, May 14, 2003—Vol 289, No. 18 2387‐92

 Approaches to Palliative Care

 Not a “one size fits all approach”

 Care is tailored to help the specific needs of the patient
 Since palliative care is utilized to help with various diseases,
the care provided must fit the symptoms.

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 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.
What does Palliative Care Provide to
the Patient?
 Helps patients gain the strength and peace of mind to carry
on with daily life
 Aid the ability to tolerate medical treatments
 Helps patients to better understand their choices for care
What Does Palliative Care Provide
for the Patient’s Family?
 Helps families understand the choices available for care
 Improves everyday life of patient; reducing the concern of
loved ones
 Allows for valuable
support system

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Approaches to Palliative Care
A palliative care team delivers many forms of help to a patient
suffering from a severe illness, including :

Close communication with doctors

Expert management of pain and other symptoms
Help navigating the healthcare system
Guidance with difficult and complex treatment choices
Emotional and spiritual support for the patient and their family
Goals of Palliative Care
Help to
• Eat well € Live better
• Sleep well € Live longer
• Maintain
function “ Add life to days
• Reduce and days to life ”
stress
Benefits of Early Palliative Care
✓ Survival
• Longer
• Better
• Understanding
prognosis
• Goals of care
✓ Less IV chemo in
last 60 days
✓ $ Quality of Life
• Improved mood
How do we get everyone to incorporate
palliative care into practice early ?
 What Hospice
and Palliative Medicine
Mean