End Of Life Care

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

End-of-life careDr Subraham Pany


CONTENTS AND understanding OF the

PRESENTATION :An approach to the terminally ill – a learners point of view.

Understanding basics of palliative care.

How does it influences the life of a patient and his care

givers.

Domains and concerns of palliative care

How does or how should this learning influence you.


PRESENTATION

A BASIC UNDERSTANDING OF TERMINAL STAGE,

DEATH AND BEREAVMENT CONSIDERING BOTH THE

PATIENT AND FAMILY MEMBERS

UNDERSTANDING BASIC PALLIATIVE CARE


This is how we look at life.

We expect it to just go on and on.


But…what if there is a chronic disease?


Fortunately, medicine today can help us recover and

keep us comfortable.


However, at timesmedicine cannot stop

the progressof the disease.


When the doctor indicates

the end is near,the patient finds it

difficult to believe …

What! Am I serious?

What will

happen to my

family?

How long do I have?


Are you sure?

… so does the family.

What do we do?

There is nothing you can

do?


The patient and the family must feel

free to share their fears and concerns

with the doctor.

Is it rude to ask the doctor?

Will the doctor

have time to talk to

us?

What if my

question is silly?

The doctor knows

best, so why ask?


This is the time for some honest communication, the time to take some

decisions together.


No pain, no distress to the patient at any time.

Always respect the patient’s dignity, likes and the right to make decisions.

Allow the patient to express preferences about end-of-life care.


I want to die at home. I want my

wife near me when I

die.

Tell my friend to forgive me.

I want the priest to help me

pray.

No life support for me please

It is important to honour the

patient’s wishes.


Apart from pain & comfort care, end-of-life care provides: psychological, spiritual and social support.


Life eventually ends, but end-

of-life care does not.


Bereavement support helps

the family cope and start afresh.


End-of-life care is about never stopping to care, even when we cannot cure.

“Never say ‘I can not do any thing more’,Always say ‘I can do some thing more’”

Because there is always something more that we can do.

“Never say No”


The care with which we treat the dying affirms that our humanity is living.


Together we choose.


Palliative Care is an approach that improves the quality of life of

patients and their families facing the problems associated with

life-threatening illnesses, through the prevention and relief of

suffering by means of

• early identification,

• impeccable assessment and

• treatment of pain and other problems, physical, psychosocial

and spiritual.

Definition:

REF: WORLD HEALTH ORGANISATION / PALLIATIVE CARE


The Palliative Care approach aims to promote physical, psychosocial and spiritual well-being.


Good quality palliative care can be defined as the care,

which I would be happy to have given to a member of my

own family if he or she was dying, or to receive myself

when my time comes.


History of palliative care Palliative care is not new.

Care of the dying has been a constant feature of human society throughout the history.

We have ancient traditions in India of looking after those who are dying with special care and attention.

The Eighteen institutions built in India by King Asoka (273 – 232 BC) had characteristics very similar to modern hospices. He had even established a refuge for the dying in Varanasi near the sacred river Ganges.

[REF: HANDBOOK FOR CERTIFICATE COURSE IN ESSENTIALS OF PALLIATIVE CARE;REVISED FOURTH EDITION 2015]


Best known for her role in the birth of the hospice movement, emphasizing the importance of palliative care in modern medicine.

She was a prominent Anglican, nurse, physician and writer, involved with many international universities.

She helped the dying and terminally ill end their lives in the most comfortable ways possible .

She developed the first ever hospice “St Christopher’s Hospice” in 1948

Dame Cicely Mary Saunders

[REF: HANDBOOK FOR CERTIFICATE COURSE IN ESSENTIALS OF PALLIATIVE CARE;REVISED FOURTH EDITION 2015]


Empathetic

Hospice care

Death autonomy

Clear decisions

Breaking bad news

Poly pharmacy

Holistic approach

Total pain

PALLIATIVE CARE:A MULTI DISCIPLINARY & MULTI FOCUSED APPROACH


Understanding pain: touch – healing – active listening – mind shift –presence of near & dear ones.

Avoiding unnecessary interventions

Respecting ones will

Not letting the sufferer feel underprivileged

Treating and caring more through the heart than through the mind (brain)


With a crude death rate of 6.24/1000 and a population of more

than a billion, the total number of people dying every year in

India is about seven million.

More than 4 million of them would benefit from palliative care.

But only Less than 1% of those who need palliative care services

have any access to such services in the country.

Kerala is the only state in India to have medical and legislative

norms to provide palliative care to the needy.

PROBLEM SCENARIO


The present medical establishment, with its hospital-

centred services, is geared basically to look after patients

with acute illness.

This acute-care orientation is reflected in the current

emphasis on illness diagnosis, patient-initiated

consultations, and curative and/or symptom relieving

treatments.

Patients with chronic and incurable illness on the other

hand need a regular system of support available in the

community.

How should this presentation help you ???

* You should have a more empathetic attitude towards the sufferer.

* We must understand that caring doesn't end with the death of the patient.

* Care should be by involving family and other health associates.

* Pain is not just physical, its more of the mind.

* A fundamental understanding of WHO pain ladder.

* Judicious use of analgesics.

* Palliative care is / can be given along with other on going therapies.

* And PLAN YOUR DEATH–DEATH AUTONOMY/DEATH WILL.

KEY POINTS TO REMEMBER:Palliative care is not necessarily for the terminally ill

It is not only for cancer patients

Morphine is the best analgesic to be given for refractory pain

management cases / for severe unbearable pain

Oral morphine is effective than I.V

(Morphine doesn't causes addiction, respiratory distress or any

major adverse effects)

Palliative medicine is a community approach.

Palliative care affirms dignity at end of life and ensures

bereavement care.

A good death is achieved when: • The patient’s pain and other physical symptoms have been adequately controlled

• The patient has had time to

- Evaluate his Life Journey

- Review his achievements and failures

- Forgive and ask for forgiveness

- Reconcile with self, family and God

- Say ‘I love you’

- Accept death and be ready to say ‘Good Bye’

Ultimately, the goal is to do what is good for the patient and as life is drawing to a close, to lead him towards a ‘good’ or peaceful death.

Plan your life so that you can live fully. Plan your death so that you can die peacefully.

“ LOVE YOUR LIFE - TO - DEATH “

End Of Life Care

Health & Medicine

Transcript of End Of Life Care