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Hospice and palliative care
1. Hospice and Palliative Care
Dr. Hadi Awad Hmoud
MB.Ch.B, FICMS-S, MRCS-Ireland, LMCC-Canada
2. Facts.
Why we need Hospice or palliative
care.
What palliative care means
Obstacles for palliative care.
Hospice Approach
Which on is superior to other
Objectives
3. FACTS
Death is inevitable, it is rather a normal
process.
Death does not always mean staff failure.
Sometimes we unnecessarily waist our
resources to prolong life.
Most patients fear not from death itself,
but from the way of their death.
Patient wants to die in peace NOT in
pieces.
Care must be offered for dying patient and
caregiver too.
4. Rationale Questions
1-Are we meeting our dying patients’
and caregivers’ demands, like Good
Death (comfortable and suffering free),
Truth Telling, Good Quality of Life,
Good place for death.
2-Are we trained or willing to do so?
3-Are we equipped with tools of doing
so?
4-Are these demands unreachable?
5. The Nature of Suffering
and the Goals of Medicine
The relief of suffering and the cure of disease
must be seen as twin obligations of a medical
profession that is truly dedicated to the care
of the sick. Physicians’ failure to understand
the nature of suffering can result in medical
intervention that , not only fails to relieve
suffering but becomes a source of suffering
itself.
Cassell, Eric NEJM 1982;306:639-45.
6. Symptoms at the End of Life:
Cancer vs. Other Causes of Death
Cancer Others
Pain 84% 67%
Trouble breathing 47% 49%
Nausea and vomiting 51% 27%
Sleeplessness 51% 36%
Confusion 33% 38%
Depression 38% 36%
Loss of appetite 71% 38%
Constipation 47% 32%
Bedsores 28% 14%
Incontinence 37% 33%
Seale and Cartwright, 1994
7.
8. Cure vs. Palliation
Cure:
Hope is eradication of disease.
Cure costs sacrifices.
Palliation:
Hope is comfort.
Any intervention that relieves
suffering is acceptable
9. How could we assess the patient’s
needs?
Physical.
Psychological.
Spiritual.
Social.
10. OLD MODEL OF CARE
CURATIVE
PROLONGATION
OF
LIFE
D
I
A
G
N
O
S
I
S
PALLIATIVE
RELIEF OF
SUFFERING
D
D
Predominantly curative
D
E
A
T
H
11. Curative Treatment
(Cancer, CHF, COPD, AIDS,
Dementia debilitating
Neurological diseases …)
Palliative Treatment
Bereavement Care
Hospice
DeathDiagnosis
Most Recent MODEL OF CARE
New aspects
12. Palliative care
is specialized medical care for
people with end-stage illnesses. It
focuses on relieving suffering and
improving quality of life, regardless of
the diagnosis.
It strives to focus on both the
patient and the family (Caregivers).
It is provided by a multidisciplinary
team of doctors, nurses, and other
specialists to provide efficient
support.
13. It helps patients and their families in
navigating the healthcare system.
It offers guidance for difficult and
complex treatment choices.
It provides emotional and spiritual
support for patients and their families
15. Obstacles for palliative care
Delay of the decision making .
Costs.
Social and cultural issues.
Shortage of facilities.
16. Continue
Opiate especially Morphine restriction:
morphine is not readily available across
the country. It is recommended to be
given frequently and extended to a long
period.
17. Continue
Lack of trust between staff and
family.
Patient and family education
including other caregivers.
Education and training of palliative
care for medical staff, particularly
physicians and nurses is not
available.
21. Blue: Surveyed, Red: Officially registered
Rate and type of malignancies in Basra in 2008
22. Good Palliation Indicator
Morphine consumption can be used as an
approximate measure of pain control and
hence success of this form of palliative
care.
Developing countries consumed only 6%
of global consumption of morphine. (almost
80 percent of the world's population)
10 countries together accounted for 87% of
total world consumption of morphine.
International Observatory on End of Life Care
23. Average daily consumption of defined daily doses (for statistical purposes)
of morphine per million inhabitants, 2000-2002
Source: International Narcotics Control Board Narcotic Drugs: Estimated World Requirements for 2004.
Statistics for 2002. New York: United Nations, 2004.
A limited range
Morphine Consumption
24. Hospice
Is specialized care for patients who
have been given a terminal diagnosis
with a grief prognosis.
Offers care for the whole person,
focusing on pain and symptom
management, psychological, social,
and spiritual care. Hospice seeks to
relieve suffering while focusing on
dignity and quality of life.
25. It is a support to patients and
family members throughout the dying
Process.
It offers bereavement follow up for
primary caregivers and family
members.
It is an appropriate opportunity for
patients to meet those who shared
them the sufferings
It is done in purposeful founded
Place(ACCOMODATION).
26.
27. Which one does work better for Iraq
Personaly I believe that Hospice is superior to
Palliation for these reasons:
1-It minimizes the Cost on family.
2-It is suitable for our low educated society.
3-It mininmizes the burden of relentless seek
for cure.
4-Cost-effective for the budget and resources.
28.
29.
30. Elderly Palliative care, the right to quality of lifeElderly Palliative care, the right to quality of life