ico dir. the ‘qualy’ end of life care observatory - who collaborating centre for public health...
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ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Lecture 2: Basics of palliative care: model of needs and model of care
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Agenda• We need answers…• Clinical / individual perspective• The symptoms and the consequences• The Model of Needs• Model of Intervention: SQUARE OF CARE• Basis of Palliative Care • Model of care : The Model of ICO• Basic Competences• Nuclear Needs• Personal Behaviors and Values• Model of Micro-organization• In conclusion…..
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
We need answers…
• How do you feel when are you suffering?
• How do you want to be care?
• What is a good professional of palliative care?
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The clinical / individual perspective
What is your current situation?
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Old people with chronic and advance disease….
Young people with advance disease….
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
McNamara, 2006Minimal: 50%, Mid-range: 55.5 %, High range: 89.4%
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Death trajectories. Lunney JR, et al. Profiles of older Medicare
decedents. J Am Geriatr Soc 2002;50:1108-1112.
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
2
Murray, S. A et al. BMJ 2008;336:958-959
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
3
Murray, S. A et al. BMJ 2008;336:958-959
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Characteristics of terminal situation
• Disease or diseases: Advanced, progressive, incurable
• Treatment: reduced chance response to specific• Limited prognosis • Symptoms: multiple, multifactorial changing,
severe, different by diseases • Emotional impact on patient, family, and teams• Frequent crisis of needs• Frequent ethical dilemmas• Frequent need and demand of resources
SECPAL 2002, and XGB et al, 2009
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The symptoms and the consequences
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
SYMPTOM PATIENTS (%) SYMPTOM PATIENTS (%)
Pain 84 Edema 28
Easy fatigue 69 Taste change 28
Weakness 66 Hoarseness 24
Anorexia 66 Anxiety 24
Lack of energy 61 Vomiting 23
Dry mouth 57 Confusion 21
Constipation 52 Dizziness 19
Early satiety 51 Dyspepsia 19
Dyspnea 50 Dysphagia 18
Weight loss 50 Belching 18
Sleep problems 49 Bloating 18
Depression 41 Wheezing 13
Cough 38 Memory problems 12
Nausea 36 Headache 11
Most Common Symptoms of Patients with Advanced Cancer
Walsh D, Donnelly S, Rybicki L. Support Care Cancer 2000;8:175-179.
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
0
10
20
30
40
50
60
70
80
90
DEB PES ANOR DOLOR XER SOMN CONS INS NAU TOS
FREC
CONTROL
Frequency and degree of control of 10 symptoms at “Morir de Càncer” XGB et al, 1996
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
SYMPTOM HOSPICE NURSES SELECTING THE SYMPTOM (%)
Agitation 45
Pain 40
Shortness of breath
34
Confusion 33
Pressure ulcers 27
Nausea 26
Fatigue 25
Constipation 24
Depression 22
Anxiety 21
From Johnson DC, Kassner CT, Houser J, Kutner JS. Barriers to effective symptom management in hospice. J Pain Symptom Manage 2005;29:69-79.
Symptoms difficult to manage
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
How do you feel when you suffer?
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Consequences of terminal situation
Suffering, difficult experience, impact, isolation, multiple crisis
• High need and high demand of care and services
• Frequent emergencies and admissions
• Frequent ethical decisions
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The model of needs
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Characteristics of needs
Multidimensional Evolutive Crisis Ethical dilemmas
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Model of needsFrom Saunders to Ferris….
Frank D. Ferris, MD is the Director, International Programs, San Diego Hospice & Palliative Care, a teaching affiliate of the University of California, San Diego, School of Medicine.
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
1.ILLNESS MANAGEMENT
1.ILLNESS MANAGEMENT 2. PHYSICAL2. PHYSICAL 3. PSYCHOLOGICAL3. PSYCHOLOGICAL
8. LOSS, BEREAVEMENT
8. LOSS, BEREAVEMENT
7. CAREAT THE END OF LIFE / DEATH MANEGEMENT
7. CAREAT THE END OF LIFE / DEATH MANEGEMENT
4. SOCIAL4. SOCIAL
5.SPIRITUAL5.SPIRITUAL6. PRACTICAL6. PRACTICAL
PATIENT & FAMILYPATIENT & FAMILY
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
1. ILLNESS MANAGEMENT
•Primary diagnosis, prognosis, tests•Secondary diagnosis (for example, dementia, psychiatric diagnosis, use of drugs, trauma)•Co-morbid (delirium, attacks, organs failure)•Adverse episodes (collateral effects, toxicity)
1. ILLNESS MANAGEMENT
•Primary diagnosis, prognosis, tests•Secondary diagnosis (for example, dementia, psychiatric diagnosis, use of drugs, trauma)•Co-morbid (delirium, attacks, organs failure)•Adverse episodes (collateral effects, toxicity)
2. PHYSICAL•Pain & other symptoms•Conscience level, cognition•Function, safety, materials:•Motor (mobility, shallowness, excretion)•Senses (hearing, sight, smell, taste, touch)•Physiologic (breathing, circulation)•Sexual•Fluids, nutrition, wounds•Habits (alcohol, smoking)
2. PHYSICAL•Pain & other symptoms•Conscience level, cognition•Function, safety, materials:•Motor (mobility, shallowness, excretion)•Senses (hearing, sight, smell, taste, touch)•Physiologic (breathing, circulation)•Sexual•Fluids, nutrition, wounds•Habits (alcohol, smoking)
3. PSYCHOLOGICAL•Personality, strengths, behavior, motivation •Depression, anxiety•Emotions (anger, distress, hope, loneliness)•Fears (abandonment, burdens, death)•Control, dignity, independence•Conflict, guilt, stress, assuming answers•Self-image, self-esteem
3. PSYCHOLOGICAL•Personality, strengths, behavior, motivation •Depression, anxiety•Emotions (anger, distress, hope, loneliness)•Fears (abandonment, burdens, death)•Control, dignity, independence•Conflict, guilt, stress, assuming answers•Self-image, self-esteem
8. LOSS, BEREAVEMENT•Loss •Pain (for example, chronic acute, anticipatory)•Bereavement planning•Mourning
8. LOSS, BEREAVEMENT•Loss •Pain (for example, chronic acute, anticipatory)•Bereavement planning•Mourning
7. CARE AT THE END OF LIFE/DEATH MANAGEMENT•End of life (businesses ending, relationships closing, to say goodbye)•Delivery of gifts (objects, money, organs, thoughts)•Creation of legacy•Preparation for the awaited death•Anticipation changes in agony•Rituals•Certification•Care of agony•Funerals
7. CARE AT THE END OF LIFE/DEATH MANAGEMENT•End of life (businesses ending, relationships closing, to say goodbye)•Delivery of gifts (objects, money, organs, thoughts)•Creation of legacy•Preparation for the awaited death•Anticipation changes in agony•Rituals•Certification•Care of agony•Funerals
4. SOCIAL•Values, cultural, beliefs, practices•Relations, roles with the family, friends, community•Isolation, abandonment, reconciliation •Safe, comforting environment•Privacy, intimacy•Routines, rituals, leisure, vocations•Financial resources, expenses•Legal (powers of attorney for businesses, health attention, advanced directives, last desire/testament beneficiaries)
4. SOCIAL•Values, cultural, beliefs, practices•Relations, roles with the family, friends, community•Isolation, abandonment, reconciliation •Safe, comforting environment•Privacy, intimacy•Routines, rituals, leisure, vocations•Financial resources, expenses•Legal (powers of attorney for businesses, health attention, advanced directives, last desire/testament beneficiaries)
5.SPIRITUAL•Significance, value•Existential, transcendental•Values, beliefs, practices, affinities•Spiritual advisors, rituals•Symbols, icons
5.SPIRITUAL•Significance, value•Existential, transcendental•Values, beliefs, practices, affinities•Spiritual advisors, rituals•Symbols, icons
6. PRACTICAL•Everyday activities (personal care, home work)•Dependents, pets•Access to telephone, transport•Care
6. PRACTICAL•Everyday activities (personal care, home work)•Dependents, pets•Access to telephone, transport•Care
PATIENT & FAMILYCharacteristicsDemographic (age, sex, race, contact information)Culture (ethnic, language, nurture)Personal values, beliefs, practices, strengthsDevelopment status, education, alphabetizationDisabilities
PATIENT & FAMILYCharacteristicsDemographic (age, sex, race, contact information)Culture (ethnic, language, nurture)Personal values, beliefs, practices, strengthsDevelopment status, education, alphabetizationDisabilities
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Patient / Family
Characteristics
Demographic (age, sex, race, contact information)
Culture (ethnic, language, nurture)
Personal values, beliefs, practices, strengths
Development status, education, alphabetization
Disabilities
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
1. Illness management
• Primary diagnosis, prognosis, tests• Secondary diagnosis (for example, dementia, psychiatric
diagnosis, use of drugs, trauma)• Co-morbid (delirium, attacks, organs failure)• Adverse episodes (collateral effects, toxicity)
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
2. Physical
• Pain and other symptoms• Conscience level, cognition• Function, safety, materials:• Motor (mobility, shallowness, excretion)• Senses (hearing, sight, smell, taste, touch)• Physiologic (breathing, circulation)• Sexual• Fluids, nutrition, wounds• Habits (alcohol, smoking)
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
3. Psychological
• Personality, strengths, behavior, motivation • Depression, anxiety• Emotions (anger, distress, hope, loneliness)• Fears (abandonment, burdens, death)• Control, dignity, independence• Conflict, guilt, stress, assuming answers• Self-image, self-esteem
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
4. Social
• Values, cultural, beliefs, practices• Relations, roles with the family, friends, community• Isolation, abandonment, reconciliation • Safe, comforting environment• Privacy, intimacy• Routines, rituals, leisure, vocations• Financial resources, expenses• Legal (powers of attorney for businesses, health
attention, advanced directives, last desire/testament beneficiaries)
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
5.Spiritual
• Significance, value• Existential, transcendental• Values, beliefs, practices, affinities• Spiritual advisors, rituals• Symbols, icons
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
6. Practical
• Everyday activities (personal care, home work)• Dependents, pets• Access to telephone, transport• Care
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
7. Care at the end of life/ death management
• End of life (businesses ending, relationships closing, to say goodbye)
• Delivery of gifts (objects, money, organs, thoughts)• Creation of legacy• Preparation for the awaited death• Anticipation changes in agony• Rituals• Certification• Care of agony• Funerals
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
8. Loss, bereavement
• Loss • Pain (for example, chronic acute, anticipatory)• Bereavement planning• Mourning
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The model of interventionThe Square of Care
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The process of care
Needs patients and families
1. Assessment 2. Sharing information, ethical decision-making, define aims
4. Plan of care 5. Care activities
7. Measure results, review, update
Disease management
Physical
Emotional
Spiritual
Ethical
Family
Social
Practical
End of Life
Grief and loss
“The square of care” (Modified from Ferris F, XGB, Furst CJ, Connor S, JPSM, 2007)
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Therapeutic Relationship
TimePresentation Diagnosis Discharge /
Death
“The square of care”
(Ferris F, 2007)
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
2. Share information• Confidentiality limits• Desire and
readiness for information
• Process for sharing information
• Translation• Reactions to
information• Understanding• Desire for additional
information
2. Share information• Confidentiality limits• Desire and
readiness for information
• Process for sharing information
• Translation• Reactions to
information• Understanding• Desire for additional
information
3. Decisions• Capacity• Goals for care• Issue prioritization• Therapeutic options• Treatment choices,
consent• Withholding,
withdrawing therapy,, hastened death
• Surrogate decision-making
• Advance directives• Conflict resolution
3. Decisions• Capacity• Goals for care• Issue prioritization• Therapeutic options• Treatment choices,
consent• Withholding,
withdrawing therapy,, hastened death
• Surrogate decision-making
• Advance directives• Conflict resolution
4. Plan care • Setting of care• Process to
negotiate and develop plan of care that addresses issues and opportunities, delivers chosen therapies
• Includes plan for dependents, backup coverage, respite care, emergencies
• Discharge planning• Bereavement care
4. Plan care • Setting of care• Process to
negotiate and develop plan of care that addresses issues and opportunities, delivers chosen therapies
• Includes plan for dependents, backup coverage, respite care, emergencies
• Discharge planning• Bereavement care
5. Do Care • Care team
composition, leadership,coordination, facilitation, education, training, support
• Consultation• Setting of care• Essential services• Support network• Therapy delivery• Process• Storage, handling,
disposal• Infection control• Errors
5. Do Care • Care team
composition, leadership,coordination, facilitation, education, training, support
• Consultation• Setting of care• Essential services• Support network• Therapy delivery• Process• Storage, handling,
disposal• Infection control• Errors
1. Evaluation• History of active and
potential issues, opportunities for growth, expectations, needs, hopes, fears
• Examination (assessment scales, physical examination, laboratory, radiology, procedures)
1. Evaluation• History of active and
potential issues, opportunities for growth, expectations, needs, hopes, fears
• Examination (assessment scales, physical examination, laboratory, radiology, procedures)
6. Confirm• Understanding• Satisfaction• Complexity• Stress• Concerns, other
issues, questions• Ability to participate in
the plan of care
6. Confirm• Understanding• Satisfaction• Complexity• Stress• Concerns, other
issues, questions• Ability to participate in
the plan of care
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The basis of palliative care
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
How do you want to be care?
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Definition
• "An approach that improves the quality of life of patients and their families facing problems associated with life-threatening illnesses through prevention and relief of suffering by early identification and impeccable assessment and treatment of pain and other physical, psychological and spiritual problems”
WHO 2002
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
First of all
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Main aims
Avoid the avoidable sufferingAvoid the avoidable suffering
Building Capacity : empowerment to adjust, relief and support the unavoidable suffering
Wellbeing
Promote comfort
Improve the Quality of Life
Comprehensive Care
OMS 2002
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Values
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Principles
•We are focused on the patient and his/her family
•We are Accessible
•We are Collaborative
•We provide high quality:
•We are Safe and Effective
•We are based on Evidence
•We have resources
Ferris and Gómez- Batiste
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
10 instruments for palliative care1. Needs assessment.2. Systematic therapeutic Plan.3. Symptom control.4. Emotional support.5. Information and communication.6. Clinical ethics as the method for decisions7. Change in the micro organization: the team work8. Change in the organization of resources.9. Evaluation and monitoring results quality and results.10. Education, training, and research
And….. Advance Care Planning and Case management and continuity of care
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The Model of Care
The model of ICO
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
• Centered on the relation Patient-Professional
• “Style” and behaviors related to the individual professional values, and skills
• Not only based on technical aspects
• Applicable by any professional, and in any context, service and situations
• Pragmatic, feasible
Characteristics of the model
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Clinical Communication Ethical /ACP Continuity
Context: Team / Atmosphere / Values Organization oriented to patients and families
Respect / Spiritual / Dignity / Hope
Values: commitment, empathy, compassion, honesty, congruence, trust, confidence, ….
Basic Competences
“You matter”“You matter”
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The Basic Competences
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Basic Competences I
1. Clinical skills:
•Assessment •Disease management •Symptom control•Use of drugs: opioids and others
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Basic Competences II2. Communication skills. • Therapeutic attitudes• Basic Skills to communicate• Assertively• Counseling• To recognize the emotional issues• Validation• Crisis management• Emotional support• Setting Modified from J Barbero, 2009
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
3. Ethical decision- making
Basic Competences III
We have to preserve the patient’s authonomy, promoting its welfare, always trying not to be maleficent and in a context of an equal distribution of resources for everyone
We have to….
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Basic Competences III3. Advance Care Planning II
A process and an attitude…
Professionals have to explore
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Advance Care Planning
As a process:• Qualitative and
progressive• Carefully• Integrative: patient
and family• Preventive• Registered• Follow-up
As an attitude: • To recognize “the
other”• Based on respect• Communication skills
are necessary• Competence required• Confidence• Accessibility
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Basic Competences IV4. Continuity of care and Case Management
• Continuity: commitment to accessibility in any circumstance, specially in response to crisis
• Reference: being advocate of patients’ trajectory
• Case management : planning and follow up of appropriate resources and accessibility
• Interdisciplinary Coordination • Share information• Continued learning• Care-givers’ support• Care in the dying phase
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
The nuclear needs
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Nuclear needs of patients
1. Spiritual
2. Dignity
3. Hope
4. Respect
“To be considered as a person”
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
1. Spiritual needs
• Sense of life/ Significance • Trascendence• Legacy• The others ( the love one’s)
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
2. Dignity
The essence of “You Matter”
A: AttitudesB: BehaviorsC: CompassionD: Dialogue
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
3. Hope/ Hopefully
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
4. Respect
To be recognized as a person
To care as we would like to be cared….
We need to explore more…..
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Personal Behaviors and Values
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Personal behaviors / and values
• Empathy• Compassion• Commitment• Coherence• Honesty• Congruence• Others
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Bmj What’s a good doctor? 2002
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Model of micro-organization
A systematic approach to multidimensional needs practiced by a competent interdisciplinary team with ethical decision-making, case management, and advance care planning
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
Integrated model
Diagnosis Death
Specific cancer treatment
Supportive Care
Palliative care
Terminal care
Bereavement
Complexity vs prognosis Flexible, shared, cooperative
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia
In conclusion……
ICO DiR. The ‘Qualy’ End of Life Care Observatory - WHO Collaborating Centre for Public Health Palliative Care Programmes Institut Català d’Oncologia