Palliative Care

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Julianna Tambellini, Meredith Hennon, University of PittsburghUSA

What is Palliative Care?

Medical care that focuses on alleviating the intensity of symptoms of disease.

Palliative care focuses on reducing the prominence and severity of symptoms.

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 impeccable assessment 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;

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.

WHO Definition of Palliative Care (cont.)

What is the goal of Palliative Care?

The goal is to improve the quality of life for individuals who are suffering from severe diseases.

Palliative care offers a diverse array of assistance and care to the patient.

The History of Palliative CareStarted as a hospice movement in the 19th

century, religious orders created hospices that provided care for the sick and dying in London and Ireland.

In recent years, Palliative care has become a large movement, affecting much of the population.

Began as a volunteer-led movement in the United states and has developed into a vital part of the health care system.

Palliative vs. Hospice CareDivision made between these two terms in

the United StatesHospice is a “type” of palliative care for

those who are at the end of their lives.

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Palliative vs. Hospice CarePalliative care can be provided from the

time of diagnosis.Palliative care can be given simultaneously

with curative treatment.Both services have foundations in the same

philosophy of reducing the severity of the symptoms of a sickness or old age.

Other countries do not make such a distinction

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)

Cancer and Palliative CareIt is generally estimated that roughly 7.2 to 7.5

million people worldwide die from cancer each year.

 More than 70% of all cancer deaths occur in developing countries, where resources available for prevention, diagnosis and treatment of cancer are limited or nonexistent.

More than 40% of all cancers can be prevented. Others can be detected early, treated and cured. Even with late-stage cancer, the suffering of patients can be relieved with good palliative care.

Palliative Care and Cancer Care

Palliative care is given throughout a patient’s experience with cancer.

Care can begin at diagnosis and continue through treatment, follow-up care, and the end of life.

Palliative Care and Cancer"Everyone has a right to be treated, and die,

with dignity. The relief of pain - physical, emotional, spiritual and social - is a human right," said Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. "Palliative care is an urgent need worldwide for people living with advanced stages of cancer, particularly in developing countries, where a high proportion of people with cancer are diagnosed when treatment is no longer effective."

“Cancer Control: Knowledge Into Action”

Excerpts from the WHO guide for Palliative Care:

“Palliative care is an urgent humanitarian need worldwide for people with cancer and other chronic fatal diseases. Palliative care is particularly needed in places where a high proportion of patients present in advanced stages and there is little chance of cure.”

Who Provides Palliative Care?Usually provided by a team of individualsInterdisciplinary group of professionalsTeam includes experts in multiple fields:DoctorsNursessocial workersmassage therapistsPharmacistsNutritionists

Patient

andFamily

VolunteersPhysicians

Spiritual Counselo

rs

Social Workers

Pharmacists

Home Health Aides

Therapists

Nurses

Approaches to Palliative Care

Not a “one size fits all approach” Care is tailored to help the specific needs of

the patientSince 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 Services3. 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 CareA palliative care team delivers many forms of help to a patient suffering from a severe illness, including :

Close communication with doctorsExpert management of pain and other symptomsHelp navigating the healthcare systemGuidance with difficult and complex treatment choicesEmotional and spiritual support for the patient and their family

Palliative Care Is EffectiveSuccessful palliative care teams require

nurturing individuals who are willing to collaborate with one another.

Researchers have studied the positive effects palliative care has on patients. Recent studies show that patients who receive palliative care report improvement in:

Pain and other distressing symptoms, such as nausea or shortness of breath

Communication with their doctors and family members

Emotional and psychological state

Where to find Palliative Care?In most cases, palliative care is provided in

the hospital. The process begins when doctors refer

individuals to the palliative care team.In the hospital, palliative care is provided

by a team of experts.The Palliative Care Provider Directory of

Hospitals at www.getpalliativecare.org can locate hospitals which provide palliative care.

Settings for Palliative Care Outpatient practiceHospital Inpatient

Unit basedConsultation Team

Home careNursing HomeHospice

Cost of Palliative CareMost insurance plans cover all or part of

the palliative care treatment given in hospitals.

Medicare and Medicaid also typically cover palliative care.

Palliative Care is GrowingData suggest there is growth in palliative

care programs throughout the nation's hospitals, larger hospitals, academic medical centers, not-for-profit hospitals, and VA hospitals are significantly more likely to develop a program compared to other hospitals.

Palliative Care is Universal

Numerous governments have already adopted national palliative care policies, including Australia, Canada, Chile, Costa Rica, Cuba, France, Ireland, Norway, Spain, Uganda, South Africa and the United Kingdom.

Palliative Care in WPROThe Western Pacific Regional Office (WPRO)

represents the WHO in 37 countries of Asia Pacific.

About a quarter (25%) of the countries in the WPRO region have an established system (“approaching integration”) for palliative care that encompasses the entire country or have services typically in large cities or highly populated regions (“localized provision”).

Countries with established systemsAustralia

In 1987, Ian Maddocks accepted the world’s first Chair in Palliative Care at Flinders University.

Palliative care is recognized as a medical specialty in 2005.Around 320 palliative care services are operational.

JapanPalliative care standards were first introduced in 1997.Palliative care education is included in the curriculum of most

medical schools in the country and all nursing schools.120 services related to palliative care are available country-

wide.

Singapore13 organizations providing palliative care.Palliative care module added to medical school curriculums.

Countries with established systemsMalaysia

In 1998, the Government began requiring every district and general hospital to introduce a palliative care provision.

MongoliaPalliative care incorporated into National health plan.Palliative care module included in medical school

curriculum.

New ZealandA palliative care education program has been

established for care assistants.41 services are currently delivering palliative care

throughout the country.

Countries with localized provisionsChina South KoreaPhilippinesVietnam

Countries with building capacityBrunei DarussalamFiji Papua New Guinea

The countries are aiming to create conditions for the development of programs focused on palliative care.

Countries with no palliative careAmerican SamoaCook IslandsFrench PolynesiaGuamKiribatiLaosMarshall IslandsMicronesiaNauruNew CalendoniaNiue

Northern Mariana Islands

PalauPitcairn IslandsSamoaSoloman IslandsTokelauTongaTuvaluVanuatuWallis and Futuna

WPRO Palliative Care Systems

Bibliographyhttp://www.who.int/cancer/palliative/definiti

on/en/

http://www.who.int/cancer/media/FINAL-Palliative%20Care%20Module.pdf

http://www.cancer.gov/cancertopics/factsheet/support/palliative-care

http://en.wikipedia.org/wiki/Palliative_carehttp://www.getpalliativecare.org/whatishttp://

www.nlm.nih.gov/medlineplus/palliativecare.html

http://www.nhpco.org/i4a/pages/index.cfm?pageid=5953

http://www.liebertonline.com/doi/abs/10.1089/jpm.2005.8.1127