Principles of Palliative care

Dr Ibrahim Bashaireh

Palliative derives from the Latin Pallium which means to cloak.

Palliation means to cloak over, to not address the underlying causes, but to eliminate the effects.

History of Palliative Care

4 th Century Christians

1842 Jeanne Garnier Lyon France

1879 Irish Sisters of Charity Dublin

1905 St Joseph’s London

1967 St Christopher’s London

Independent Sector

Marie Curie

Independent Hospices

Macmillan Cancer Relief

Public Sector

NHS Hospices

Palliative Care Beds

% Funding for Hospices

Palliative care (WHO, 2003)

“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, psychological and spiritual.”

Definition of Palliative Care (contd)

The goal of palliative care is achievement of the best

possible quality of life for patients and their families

Affirms life and regards dying as a normal process

Provides relief from pain and other distressing

symptoms

Integrates the psychological and spiritual aspects of

patient care

Offers a support system to help patients live as

actively as possible until death

To help the family cope during the patients illness and

in their own bereavement

First of all

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

Values

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

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

Emotional

PsychosocialPhysical

Spiritual

Bereavement Symptom

Control

General Palliative Care Patients with less complexed needs Nursing Homes, PC approach,

Specialist Patients with complexed needs. Multi-professional

team with specialist PC training. Medical, Nursing, Social Work, Spiritual, Physio, OT, Pharmacy

Supportive Provided from pre-diagnosis onwards. Umbrella

term for general & specialist services. Responsibility of all Health & Social care professionals

The Palliative Care Approach NCPC (1997)

The Palliative Care Approach NCPC (1997) Vital and integral part of all clinical practice.

Informed by a knowledge of and practice of palliative care principals and supported by specialist palliative care

Quality of life A whole person approach

Care for both the dying person and those that matter to the person

Patient autonomy and choice

Principles underlying palliative care

provision (NCPC 1997)

Principles underlying palliative care

provision (NCPC 1997)

It is the right of every person with a life threatening

illness to receive appropriate palliative care wherever

they are.

It is the responsibility of every health care professional

to practice the palliative care approach, and to call in

specialist palliative care colleagues if the need arises,

as an integral part of good clinical practice whatever

the illness or stage.

What kind of issues would effect when or why people access palliative care services?

Consider:

Resources available

Regional differences

Education/information

History

When ?

Diagnosis Death

Active – Treatments

Palliative Care

Time

56% wanted to die at home 25% of Cancer patients did 20% of people with other diseases did 11% wanted to die in hospital 47% of Cancer patients did 56% of people with other diseases did

24% wanted to die in a hospice. 17% of Cancer patients did 4% of people with other diseases did

National Council for Palliative Care 2003

Frequency of common symptoms in advanced illness(Atkinson & Virdee, 2001)

Symptom Patients with cancer

Patients with progressive non-malignant disease

Pain

Breathlessness

Vomiting or nausea

Sleeplessness

Confusion

Depression

Anorexia

Constipation

Pressure sores

Loss of bladder control

Loss of bowel control

Unpleasant smell

84

47

51

51

33

38

71

47

28

37

25

19

67

49

27

36

38

36

38

32

14

33

22

32

Palliative Care Nursing

Palliative care nursing

Doing for

Preserving

integrity

empowering

Finding meaning

VALUING

connecting

Palliative care nursingPalliative care nursingConnecting

Making a connection

– establishing a rapport

– building up trust

Maintaining a connection

– being available, spending time, sharing secrets, sharing self,

maintaining trust.

Breaking the connection

– usually as a result of the patient’s death

Empowering..... facilitating –

– recognises patient autonomy

encouraging

defusing

– dealing with negative feelings

mending

– - facilitating healing

giving information

Palliative care nursingPalliative care nursing

Doing for......

Taking charge

– symptom control

– making

arrangements

Team playing

– acting as the

patient’s advocate

Finding meaning

Focusing on living -

helping the patient to

live as fully as possible

Acknowledging death

– giving or reiterating

bad news

– talking about death

and the time left

Preserving Integrity

Confronting own mortality

Burnout Supporting

Colleagues

Hope

Comfort

Attachment

Worth

Hope D

iminishing

Hope S

us tai ning

Physical distress Physical Ease

Abandonment

& Isolation

Caring relationships

Feeling devalued Feeling valued

Hope nurturing interventions in palliative care

ComfortAssessment, psychosocial issues.

AttachmentBe there, caring environment, promote

communication

WorthExplore previous experience, future

wishes,enhance independence

The tyrannies of palliative care (Aranda, 2001)

Niceness

Glowing testimonial

Depressing/Sad

Passive

Ethics

Treatment OptionsFeeding/Fluids

Sedation

CPR

Carers

Euthanasia