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Palliative Care

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WHO Definition of Palliative Care. Palliative care: ... Dry mouth. Aquae mouth spray. Colicky abdominal pain. Buscopan. Antiemetics. Promethazine ... – PowerPoint PPT presentation

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Title: Palliative Care


1
Palliative Care
  • Dr GB Crawford
  • Clinical Head of Palliative Care
  • Lyell McEwin Health Service

2
Who is Palliative Care for?
3
Breast cancer
THE DYING
PSYCHIATRIC DISEASE
Bowel cancer
4
DEMENTED
LUNG FAILURE
HEART FAILURE
RENAL FAILURE
5
Impact on care
6
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7
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8
Cancer death
9
COAD/Respiratory failure
10
Sudden death
11
Who needs what?
  • Palliative approach
  • Specialised Palliative Service Provision
  • Terminal care

12
Palliative approach
  • When
  • Is acute intervention the opposite of palliative?
  • Where
  • Community
  • Hospital
  • Residential care
  • Who

ALL OF YOU
13
Palliative approach
  • Attitude
  • Knowledge
  • Skills

14
Attitude
  • Centrality of symptoms as experienced by the
    patient rather than diagnosis
  • Communication with patient and family
  • Teamwork
  • Respecting differences
  • Assessment
  • Attention to detail

15
Knowledge Skills
  • Symptom assessment
  • Pain management
  • Nutrition hydration
  • Cachexia
  • Psychological support
  • depression, anxiety, delirium
  • Family support
  • Cultural issues
  • Spiritual support

16
Knowledge Skills
  • Volunteer support
  • End-of-Life care
  • Bereavement support

17
WHO Definition of Palliative Care
  • Palliative care
  • is 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.

18
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

19
WHO Definition of Palliative Care
  • Palliative care
  • 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 counselling, if indicated
  • will enhance quality of life, and may also
    positively influence the course of illness.

20
WHO Definition of Palliative Care
  • Palliative care
  • 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.

21
So what do we call ourselves?
  • Terminal care movement
  • Hospice movement
  • Palliative Care
  • Supportive Care
  • BUT nothing changes what we do

22
Consent to Medical Treatment and Palliative Care
Act
  • To refuse medical treatment
  • To have clear explanations given
  • To appoint a Medical Agent
  • To make an Advanced Directive
  • Not to end lives with/ or without consent
  • Doctrine of double effect

23
Drugs
  • Opioids
  • pain
  • breathlessness
  • Anti-emetics
  • Neuropathic agents
  • Ketamine S8

24
Opioids
  • Immediate-release Opioids
  • Morphine
  • Ordine 2, 5, 10mg/ml
  • Sevredol 10, 20mg tabs
  • Oxycodone
  • OxyNorm caps 5, 10, 20mg
  • OxyNorm liquid 5mg/5ml x 250mls
  • Hydromorphone
  • Dilaudid 1mg/ml x 473 mls

25
Opioids
  • Sustained-release Opioids
  • MS Contin 5, 10, 15, 30, 60, 100mg tab
  • MS Contin suspension 20, 30, 60, 100mg
  • MS Mono 30, 60, 90, 120mg cap
  • Kapanol 10, 20, 50, 100mg cap
  • OxyContin 10, 20, 40, 80mg tab
  • Durogesic (Fentanyl patch) 12, 25, 50, 75,
    100mcg/hr

26
Availability of medication
  • Inequities especially for non-public patients
  • Common drugs not on PBS
  • No ability to promote some products
  • Little evidence
  • Non-commercial usage
  • Bureaucracy not responsive
  • Combined COSA/PCA/ANZSPM Therapeutics Committee

27
Medications
  • Coloxyl with senna
  • Midazolam
  • Clonazepam
  • Hyoscine
  • Gabapentin
  • Fentanyl injection
  • Ketamine

28
PBS Palliative Care Drugs
  • A patient with an active, progressive,
    far-advanced disease for whom the prognosis is
    limited and the focus is the quality of life.

29
PBS Palliative Care Drugs
  • Dry mouth
  • Aquae mouth spray
  • Colicky abdominal pain
  • Buscopan
  • Antiemetics
  • Promethazine
  • Laxatives
  • Bisalax, Durolax, Fleet, Coloxyl, Granocol,
    Microlax, Glycerol

30
PBS Palliative Care Drugs
  • Analgesics
  • Paracetamol suppositories
  • Anti-epileptics
  • Clonazepam
  • prevention of epilepsy

31
How to care for yourself
32
What Is Burnout?
  • Progressive loss of idealism and commitment to
    work, leading to reduced
  • Energy and purpose
  • Role dissatisfaction
  • Negative attitudes towards patients, colleagues
    and oneself
  • It may culminate in exhaustion, depressive
    disorders and post-traumatic stress disorders

33
Care Provider
  • Protective characteristics
  • Training and Communication skills
  • Personal philosophy
  • Personal resilience

34
Care Provider
  • Vulnerability characteristics
  • Poor supports
  • Younger providers engaged in full-time care
  • Stressful life-events
  • PHx of depressive or psychiatric disorder
  • Compulsive care giving
  • Propensity to self-medicate

35
Patient
  • Protective characteristics
  • Good symptom control
  • Open communication style
  • Good psychological adjustment
  • Well-supported by family and friends

36
Patient
  • Vulnerability characteristics
  • Poor symptom control
  • Psychiatric disorders or difficulties with
    adjustment
  • Personality disorder
  • Dysfunctional family
  • Social isolation

37
Work Environment
  • Protective characteristics
  • Teamwork
  • Role definition
  • Supportive conditions
  • Appropriate staff structure

38
Work Environment
  • Vulnerability characteristics
  • Work overload
  • Role ambiguity or conflict
  • Poor teamwork
  • Administrative problems

39
Warning Signs
  • Fatigue
  • Boredom
  • Frustration
  • Low morale
  • Sleep disturbance
  • Decreased empathy
  • Increased absenteeism
  • Interpersonal problems
  • Physical symptoms

40
What can we do?
41
Have some really good friends
42
Have family time
43
Keep a childlike heart
44
Work in a team
45
Be confident and proud of yourself
46
Avoid indecisiveness
47
Work from time to time
48
Respect the weak
49
Be willing to help others
50
Get on with different kinds of people
51
Forgive others
52
Set realistic targets and goals
53
Smile
54
Share the happiness with others
55
Keep your sense of humour
56
Keep calm whatever happens
57
Learn to accept your own limitations
58
Indulge yourself, sometimes
59
What Can We Do?
  • Training
  • Limit work load
  • Vary work
  • Health
  • Take leave
  • Interests/hobbies/ creativity
  • Think positive
  • Kindness
  • Realistic expectations

60
What can we do?
  • Sense of purpose/personal philosophy
  • Debrief
  • Recognize incompatibility
  • Grieve
  • Recognize stress
  • Ask for help
  • Laugh!!!!! (Especially in a crisis)

61
What can our organisations do?
  • Resources
  • Trained staff
  • Team building and support
  • Enhance communication
  • Quality assurance
  • Administrative, financial and managerial support
  • Continuing education

62
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