Palliative Care

PPDS Ilmu Bedah

Juli 2016
 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 Organizationdescribes
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;
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.
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 Care
Started as a hospice movement in the 19 th
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 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.

Image courtesy of
http://www.ersj.org.uk/content/32/3/796.full
Palliative vs. Hospice Care
Palliative 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 Care
It is generallyestimatedthat 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
patients 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 Gals-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 individuals
Interdisciplinary group of professionals
Team includes experts in multiple fields:
Doctors
Nurses
social workers
massage therapists
Pharmacists
Nutritionists
 Volunteers
Physicians
Nurses

Patien
Therapists t Spiritual
Counselo
and rs

Family
Home
Health Aides Social
Workers
Pharmacist
s
 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.

Image courtesy of uwhealth.org

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 Patients
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

Image courtesy of mdanderson.org

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
Palliative Care Is Effective
Successful 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 practice
Hospital Inpatient
Unit based
Consultation Team
Home care
Nursing Home
Hospice
 Cost of Palliative Care
Most 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 Growing
Data 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 WPRO
The 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
systems
Australia
In 1987, Ian Maddocks accepted the worlds 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.

Japan
Palliative 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.
Singapore
13 organizations providing palliative care.
Palliative care module added to medical school curriculums.
Countries with established
systems
Malaysia
In 1998, the Government began requiring every district
and general hospital to introduce a palliative care
provision.
Mongolia
Palliative care incorporated into National health plan.
Palliative care module included in medical school
curriculum.
New Zealand
A palliative care education program has been
established for care assistants.
41 services are currently delivering palliative care
throughout the country.
Countries with localized
provisions
China
South Korea
Philippines
Vietnam
Countries with building
capacity
Brunei Darussalam
Fiji
Papua New Guinea

The countries are aiming to create

conditions for the development of
programs focused on palliative care.
Countries with no palliative
care
American Samoa Northern Mariana
Cook Islands Islands
French Polynesia Palau
Guam Pitcairn Islands
Kiribati Samoa
Laos Soloman Islands
Marshall Islands Tokelau
Micronesia Tonga
Nauru Tuvalu
New Calendonia Vanuatu
Niue Wallis and Futuna
WPRO Palliative Care
Systems
Bibliography
http://www.who.int/cancer/palliative/definition/en
/
http://www.who.int/cancer/media/FINAL-Palliat
ive%20Care%20Module.pdf
http://www.cancer.gov/cancertopics/factsheet/supp
ort/palliative-care
http://en.wikipedia.org/wiki/Palliative_care
http://www.getpalliativecare.org/whatis
http://
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/jp
m.2005.8.1127