8. Morphine equivalent
(mg/capita)
2003
Thailand 4.0
Malaysia 2.0
UK 101.7
USA 444.1
2013
Thailand 4.4
Malaysia 64.5
UK 241.4
USA 717.9
Medical opioid consumption :
Indirect measurement of palliative medicine
The Pain & Policy Studies Group global research at the University of Wisconsin
https://ppsg.medicine.wisc.edu/
9. WHO’s Level of palliative care
http://www.thewhpca.org/resources/item/mapping-levels-of-palliative-care-
development-a-global-update-2011
10.
11. Quality of death index
http://www.economistinsights.com/healthcare/analysis/quality-death-
index-2015/fullreport
13. Trend of palliative care in Thailand
• Three main streams
• Public health stream
– Community oriented
– Hospice ward in hospital
• Commercial stream
– Luxery long term care - hospice care
• Academic stream
– Research and development model
– Integrate multidisplinary experts
14. Part II :Concepts
• Different between
– การดูแลแบบบริบาลบรรเทา (Palliative care)
– การดูแลในระยะท้าย (end of life care)
– การดูแลแบบบ้านพักระยะท้าย (Hospice)
• “Why framework”
– Disease management
– Symptom management
– Spiritual management
18. Palliative care Vs End of life care
Version 1: End of life care = Terminal care
EAPC recommendation: standard and norms for hospice and palliative care 2009
http://www.eapcnet.eu/Themes/Organisation/EAPCStandardsNorms.aspx
19. Version 2:
End of life care = Prepare for good death
EAPC recommendation: standard and norms for hospice and palliative care 2009
http://www.eapcnet.eu/Themes/Organisation/EAPCStandardsNorms.aspx
20. EAPC recommendation: standard and norms for hospice and palliative care 2009
http://www.eapcnet.eu/Themes/Organisation/EAPCStandardsNorms.aspx
Graded system of Palliative care “service”
(European standard)
21. Hospice care VS Pallaitive care
• Hospice mainly based on Art & Humanities
• Palliative mainly based on Science&Medicine
‘Medical Model like a man
( Have to DO something)
Hospice Model like a woman
( Just BE there)’
Bart Gruzalski
co-founder of Houston hospice
22. Definitions
• Formal definition = WHO’s
• Practical definition = Depend on purpose
– National policy maker
• Palliative care “service” : Health economics
– Local health care
• Palliative care “approach” : Humanized
23. “WHY” Framework
• David C. Currow’s
• Critical thinking approach for symptom
management in Palliative patient
• Change form ‘ Reflex’ to ‘Reflect’ approach
• Reduce Terminal sedation
24. คล้าย อริยสัจ 4
• ทุกข์ : What is priority of concern
อาการอะไรทีสําคัญ ‘สําหรับผู้ป่วย’ ทีสุด
• สมุทัย : *Any reversible cause*
- อาการนันไม่ควรเพิมขึนตามความก้าวหน้าของโรค
- เกิดขึนฉับพลัน
• นิโรธ : What is the mutual goal
- เป้าหมายการบรรเทาอาการทีผู้ป่วย(และญาติ) ต้องการ
• มรรค : What are acceptable means
-> Solve reversible cause (Including Iatrogenic)
-> Non-Med
-> Med
25.
26. Simplify palliative care model for FM
Step objective Assess tool
(PCM)
Action tools
Disease
Management
Inform
diagnosis
and options
of treatment
I = Idea Breaking bad
news “SPIKES”
+ “NURSE”
Family support
“CAREGIVER”
Family
conference
Prognosis
determination
Illness
Management
Ensure
optimal pain
and
symptom
control
F = Feeling
F = Function
Pain /Symptom
management
guideline
Wish
management
**
Transform
“wish/dream
” to “goal”
E = Expectation Advance
directive
Dignity therapy
Gomutbutra 2012
29. CAREGIVER
• C Care ผู้ดูแลมีหน้าทีอะไรบ้าง
• A Affect รู้สึกอย่างไร
• R Rest ได้พักบ้างไหม
• E Empathy เข้าใจความลําบาก
• G Goal อยากให้เป็นอย่างไร
• I Information ให้ข้อมูลอย่างง่าย
• V Ventilation ให้ระบายความทุกข์
• E Empower ปลุกปลอบกําลังใจ
• R Resources หาแหล่งให้ความช่วยเหลือ
Jaturapatporn D.2011
44. Signs of Active Dying in 100 Cancer
Patients ( Morita,1998)
• Sign Mean/median hours prior to death (+ SD)
• Retained respiratory secretions audible (“Death
rattle”) 57/23 hours (82)
• Respirations with mandibular movement
(Jaw movement increases with breathing)
7.6 /2.5hours (18)
• Cyanosis and skin mottling
5.1/1.0 hours (11)
• No radial pulse
2.6/1.0 hours (4.2)