What is Palliative Care

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What is Palliative Care?

• Dr Sam Kyeremateng
• Consultant in Palliative Medicine Sheffield
  Teaching Hospitals Foundation Trust and St Lukes
  Hospice

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Aims

• The origins of the palliative care?
• Definitions of palliative care?
• The differences between Palliative care
  Supportive care and end of life care
• Consider practice
• Future of Palliative Care

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If you dont see it now
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Origins of Palliative care1,2

• Concept of Palliative care as old as medicine
• Term derived from Latin root word, Pallium
• Refers to an outer garment that covered or
  cloaked a person or object
• Derivation suggests palliative care can cloak the
  symptoms of terminal illness
• Origins of the term controversial
• Dr Herbert Snow (1890) and Dr Balfour Mount(1975)
  both have claims to the term

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Origins of Palliative care1,2

• Origins of modern palliative care in UK derived
  from the modern hospice movement
• The specialty of Palliative Medicine recognized
  by the Royal Colleges of Physicians in 1987
• UK is currently an international centre of
  excellence in Palliative medicine

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The UK Modern Hospice

• Cicely Saunders, OM,DBE credited with this
  development
• Held the view that dying is a phenomenon as
  natural as being born
• Developed in response to prevailing medical
  culture that death was a failure and an unnatural
  process requiring hospitalization
• Developed originally to support people with
  advanced cancer
• Proposed the process should be life affirming and
  free of pain as possible

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Palliative care and the NHS

• The modern hospice movement was funded almost
  exclusively by the Charitable sector
• Charitable funding provided for and by Cancer
  Charities reflecting the predominant focus on
  cancer patients
• Following the the NHS Cancer plan in 2000 DOH
  recognized its responsibility to provide
  palliative care in a variety of care settings
• Strategic guidance directing the development of
  services, e.g. NICE, End of life Programme

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What is Palliative care?
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WHO 1986

• The active total care of patients whose disease
  is not responsive to curative treatment
• Control of pain, of other symptoms, and of
  psychological, social and spiritual problems is
  paramount
• The goal of palliative care is achievement of the
  best possible quality of life for patients and
  their families
• Many aspects of palliative care are also
  applicable earlier in the course of the illness

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WHO 2002

• 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.3

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ESO

• Palliative care is the person-centered attention
  to physical symptoms and to psychological, social
  and existential distress and cultural needs in
  patients with limited prognosis, in order to
  optimize the quality of life of patients and
  their families or friends4

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Concepts within Palliative care

• Supportive care
• General Palliative care
• Specialist Palliative care
• End of life care
• Controversial

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Elements of Palliative care
End of life care
Supportive care
Palliative care
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ESO definition

• General or Basic palliative care is the level of
  palliative care which should be provided by all
  healthcare professionals, in primary or secondary
  care, within their duties to patients with
  life-limiting disease4

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Palliative care

• Seeks to manage the symptoms of advanced and
  terminal illness
• Views people as a whole individual rather than a
  disease process to be treated
• Body/Physical
• Mind/psychological
• Heart/social
• Soul/spiritual
• Delivers holistic care through multidisciplinary
  team working

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How do you practice Palliative care?
Hope Honesty Openness
Psychological support
Symptom relief
Team work and partnership
Twycross 2003
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Who make up the specialist palliative care team

• Physicians
• Specialist Nurses
• Therapists (OT/PT)
• Chaplains
• Social Workers
• Complementary therapists
• Is this model transferable to other settings

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Who delivers Palliative Care?
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Who delivers Palliative Care?
NICE Guidance on Cancer Services Improving
Supportive and Palliative Care for Adults with
Cancer 2004
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Who delivers Palliative Care?
NICE Guidance on Cancer Services Improving
Supportive and Palliative Care for Adults with
Cancer 2004
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Factors affecting pain2
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Who coordinates Palliative care?

• Who has overall responsibility?
• What factors affect this?
• About 90 of the final year of life is spent at
  home7
• 59 of deaths take place in hospital 8

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Who coordinates Palliative care?

• GP
• Community Matron/ Case managers
• District Nurses
• Community specialist palliative care team
• Hospital specialists
• Palliative care
• Other specialties
• THE NEED FOR COORDINATION OF CARE HAS BEEN
  RECOGNISED

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The future of Palliative care

• July 2008 Publication of End of life strategy as
  part of NHS Next stage review
• The Strategy
• Covers all conditions
• Covers all care settings (e.g. home, hospital,
  hospice, care home, community hospital, prison
  etc.)

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Palliative care and End of life care

• Department of Health Working Paper on End of
  Life Care 2007
• Adults with advanced, progressive, incurable
  illness (e.g. advanced cancer, heart failure,
  Chronic Obstructive Pulmonary Disease (COPD),
  Stroke, chronic neurological conditions and
  dementia)
• Care given in all settings (e.g. home, acute
  hospital, ambulance, residential/care home,
  nursing home, hospice, community hospital, prison
  or other institution)
• Care given in the last year(s) of life
• Patients, carers and family members (including
  bereavement care)

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Department of Health Working Paper on End of Life
Care 2007

• Exactly when end of life care begins will vary
  for each individual,
• Typically people become frailer, less mobile, and
  their symptoms and treatment needs may increase
• possible to consider end of life care beginning
  6-12 months before death and ending for family
  and carers 6-12 months after death (bereavement).

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The End of Life Care Pathway (Chapter 3)
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Challenges ahead

• Identifying trigger points to activate palliative
  care (specialist or general)
• Overcoming the concept within medical culture
  that death was a failure
• Identifying the interface between general and
  specialist palliative care for non-cancer
  patients
• Ensuring equity of service
• Developing research to improve care for those in
  need in an environment where research funding
  often focuses on cure

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Challenges ahead

• Overcoming opportunity cost
• The Big Taboo
• Maintaining charitable support and developing new
  links
• The Euthanasia debate

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Conclusion

• The origins of the palliative care?
• Definitions of palliative care?
• The differences between Palliative care
  Supportive care and end of life care
• Future of Palliative Care

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Conclusion

• Palliative care is
• Traditional component of care
• Everybodys business
• Holistic
• Collaborative
• Current

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You will by now
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References

• Story P. UNIPAC,Vol 1 The Hospice/Palliative
  Medicine approach to end of life care
• Saunders CM.(2003) Foreword. In The Oxford
  textbook of palliative medicine (ed D Doyle et
  al), pp xviii-xx. Oxford Oxford University Press
• Sepulveda C, Marlin A, Yoshida T, Ullrich. A
  palliative care The World Health Organisations
  global perspective. J Pain Symptom Manage 2002,
  24, 9196.
• S.H. Ahmedzai et al. A new international
  framework for palliative care. European Journal
  of Cancer 2004, 40, 21922200
• Twycross R. 2003. Introducing Pallaitve care
  (4e). Radcliffe Medical Press, Abingdon
• Twycross R, Wilcox A. Symptom Management in
  advanced Cancer 2001, Radcliffe Medical Press,
  Abingdon, p 17-68 3rd Ed.
• http//www.goldstandardsframework.nhs.uk/backgroun
  d_to_gsf.php
• NICE Guidance on Cancer Services Improving
  Supportive and Palliative Care for Adults with
  Cancer 2004

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Questions