currently we need to understand the role of palliative care in our patients. kapkatet hospital have strongly participated in provision of palliative services. come and witness the strong team willing to help the community.

1. Palliative Care
Cheruiyot sambu
MSCN/BSCN/DCN
CLINICAL NUTRITIONIST

2. • Palliative care (pronounced pal-lee-uh-
tiv) is specialized medical care for people
with serious illnesses. It focuses on
providing patients with relief from the
symptoms, pain, and stress of a serious
illness—whatever the diagnosis. The goal
is to improve quality of life for both the
patient and the family.

3. Definition of palliative care
• Palliative care is an approach that
improves the quality of life of patients
and their families facing the problem
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.
-WHO 2002

4. Main aims
Avoid the avoidable suffering
Building Capacity :
empowerment to adjust,
relief and support the
unavoidable suffering
Wellbeing
Promote comfort
Improve the
Quality of Life
Comprehensive
Care

5. • Interdisciplinary team care- nursing
services, medical, social, pastoral
counseling, home health aide.
• Bereavement counseling
• Dietary counseling
• Physical therapy
• Occupational therapy
• Speech therapy
• Investigations and drugs
• Durable medical equipments and
supplies.
SERVICES PROVIDED BY PALLIATIVE CARE

6. The Interdisciplinary Team
• Physicians
• Nutritionists
• Nurses
• Psychologists/psychiatrists
• Social workers.
• Physiotherapist .
• clinical psychologist .
• Pharmacist
• Volunteers
• Chaplains/pastoral care workers
• Home attendants etc

7. Why we need palliative
care?
• inappropriate communication between
physician and patient and family.
• inappropriate pain control.
• Load of symptoms in the end of life .
• Majority of diagnosed patient are in late
stage .
• Mechanical medicine, use in the
technology and rise in the life
expectancy.
• inappropriate communication between
physician and patient and family.
• inappropriate pain control.
• Load of symptoms in the end of life .
• Majority of diagnosed patient are in late
stage .
• Mechanical medicine, use in the
technology and rise in the life
expectancy.

8. What does Palliative Care
Provide to the Patient?
• Helps patients gain the strength and
peace of mind to carry on with daily
life
• Aid the ability to tolerate medical
treatments
• Helps patients to better understand
their choices for care

9. PRINCIPLES
• provides relief from pain and other
distressing symptoms;
• affirms life and regards dying as a
normal process;
• intends neither to hasten nor postpone
death;
• integrates the psychological and
spiritual aspects of patient care;

10. PRINCIPLES…
• offers a support system to help patients
live as actively as possible until death;
• offers a support system to help the
family cope during the patients illness
and in their own bereavement;
• distressing clinical complications.

11. PRINCIPLES…..
• uses a team approach to address the needs
of patients and their families, including
bereavement counseling, if indicated;
• will enhance quality of life, and may also
positively influence the course of illness;
• 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,

12. ELEMENTS OF PALLIATIVE
CARE
1.PRIMARY GOAL:
The primary goal is to prevent and
relieve sufferings imposed by disease
and their treatment, achievement of
best possible quality of life for patients
and their families regardless of the
stage of the disease or need for other
therapies.

13. Elements…
2.PATIENT POPULATION:
Patients of all ages experiencing a debilitating
chronic or life threatening illness, condition or
injury.
3.PATIENT AND FAMILY CENTERED CARE:
The uniqueness of each patient and family is
respected. The patient family constitute the
unit of care.
4.TIMING OF PALLIATIVE CARE:
It ideally begins at the time of diagnosis of a
life threatening or debilitating condition and
continues through cure, or until death and
into the family’s bereavement period.

14. Elements…..
5.COMPREHENSIVE CARE:
Palliative care employs multidimensional
assessment to identify and relieve sufferings
through the prevention or alleviation of
physical, psychological, social and spiritual
distress.
6.INTERDISCIPLINARY TEAM:
Team work is an integral part of the
philosophy of palliative care. Require the
expertise of various providers in order to
adequately assess and treat the complex
needs of seriously ill patients and their families.

15. Elements….
7. COMMUNICATION SKILLS:
Effective communication skills are
requisite in palliative care. These
includes appropriate and effective
sharing of information, active listening,
determination of goals and
preferences, assistance with medical
decision making, and effective
communication with all individuals
involved in the care of patients and
their families.

16. Elements….
8. SKILL IN CARE OF THE DYING AND BEREAVED:
Team must be knowledgeable and skilled in
providing care for the dying and the
bereaved.
9.CONTINUITY OF CARE ACROSS SETTINGS:
Palliative care is integral to all health care
delivery system settings (hospital, emergency
dept, nursing homes, home care, assisted
living facilities, outpatient and non traditional
environments such as schools. The palliative
care team collaborates with professional and
informal care givers in each of these settings.

17. Elements….
10. EQUITABLE ACCESS:
Palliative care teams should work toward
equitable access to palliative care across all
ages and patient populations, all diagnostic
categories, all health care settings including
rural communities, and regardless of race,
ethnicity, sexual preferences or ability to pay.
11. QUALITY IMPROVEMENT:
Palliative care services are committed to
the pursuit of excellence and high quality of
care which enhances the quality of life.

18. PHILOSOPHY OF PALLIATIVE
CARE
We believe
• Access is Foundational - Palliative
care services should be available to all
who require care.

19. Philosophy……
• Care is Patient-Focused – Palliative
cares strives to meet the physical,
psychological, spiritual and social
needs of patients and families.
• It is sensitive to personal, cultural and
religious values, beliefs and practices,
developmental state,and readiness to
deal with the dying process

20. Philosophy……
• People Have the Right To Choice - Each person is
an autonomous and unique individual with the
right to participate in informed discussion related
to care and to choose the best possible options
and outcomes based on that information.
• Dying is Part of Life – Palliative care affirms life.
Euthanasia and physician assisted suicide are not
considered options. Palliative care never
intentionally hastens death.
• Quality of Life Guides Decisions – Care choices
should be guided by quality of life as defined by
the patient.

21. Philosophy…….
• Team Work Is Essential – Palliative care
is a network of services most effectively
delivered by an interdisciplinary team
who rely on shared knowledge,
expertise and effective interactions.
• Service is Coordinated – A palliative
care program should promote
continuity of care across settings and
coordination amongst all involved
caregivers and programs/services.

22. Philosophy…..
• Confidentiality is Central – Patient
information is treated with the utmost
respect. Team members must adhere to
this principle.
• Care Setting Is Important – Palliative care
is provided in a patient and family focused
environment in the most appropriate care
setting. The needs and preferences of the
patient and family, as well as the resources
available, are taken into consideration.

23. Philosophy……
• Caregiver Well-Being Is Fundamental –
The provision of ongoing support to
enhance formal and informal
caregivers‛ well-being is integral to a
successful palliative care program.
• On-going Education is Essential –
Patient, family, caregiver and public
education is important to the
maintenance and enhancement of
the quality of palliative care.

24. SCOPE
• Palliative care is the specialized
medical care for people with serious
illness.
• provides relief from pain, shortness of
breath, nausea and other distressing
symptoms;
• affirms life and regards dying as a
normal process;
• intends neither to hasten nor to
postpone death;

25. SCOPE
• offers a support system to help patients
live as actively as possible;
• offers a support system to help the
family cope;
• uses a team approach to address the
needs of patients and their families;
• will enhance quality of life;
• is applicable early in the course of
illness, in conjunction with other
therapies that are intended to prolong

26. Palliative Care Patient
Support Services
Three categories of support:
1. Pain management is vital for
comfort and to reduce patients’
distress. Health care professionals and
families can collaborate to identify
the sources of pain and relieve them
with drugs and other forms of therapy.

27. Palliative Care Patient
Support Services
2. Symptom management involves
treating symptoms other than pain
such as nausea, weakness, bowel and
bladder problems, mental confusion,
fatigue, and difficulty breathing

28. Palliative Care Patient
Support Services
3. Emotional and spiritual support is
important for both the patient and
family in dealing with the emotional
demands of critical illness.

29. Cure/Life-prolonging
Intent
Palliative/
Comfort Intent
Bereavement
D
E
A
T
H
“Active
Treatment”
Palliative
Care
D
E
A
T
H
EVOLVING MODEL OF PALLIATIVE CARE

30. Curative Treatment
(Cancer, CHF, COPD, AIDS,
Dementia debilitating
Neurological diseases …)
Palliative Treatment
Bereavement Care
Hospice
DeathDiagnosis
Most Recent MODEL OF CARE
Continuum of Care

31. How could we assess the patient
needs?
• Holistic :
Physical.
Psychological.
Spiritual.
Social.

32. Example of a suggested essential drug list for
palliative care
Analgesics
Non-opioids (mild
pain)
• Acetylsalicylic acid
• Paracetamol
• Ibuprofen
Opioids (mild to
moderate pain)
Codeine
Opioids (moderate to
severe pain)
• Morphine
• Methadone
Opioid antagonist
• Naloxone
Corticosteroids
• Dexametasone
• Prednisone
Laxatives
• Senna
• Sodium ducosate
• Mineral oil
• Lactulose
• Magnesium
hydroxide
Appetite
• Prednisole
Bowel obstruction
(when surgery not
indicated)
Dimenhydrinate
Haloperidol
Hyoscine butylbromide
Metoclopramide
Anxiety, depression,
insomnia, psychosis,
Amitryptiline
• epileptic seizures
Diazepam
• Lorazepam
• Chlorpromazine
• Haloperidol
• Phenytoin
• Sodium valproate
Diarrhoea
• Codeine phosphate
• Loperamide

33. essential drug list….
Gastric protection
• Omeprazol
Fluid retention
• Furosemide
• Spironolactone
Oral candidiasis
• Cotrimoxazole
• Ketoconazole
• Nystatin
Nausea and vomiting
• Dimenhydrinate
• Holoperidol
• Metoclopramide
• Prednisolone
• Prochlorperazine

34. Morphine consumption as indicator
of effective palliative service:
• Morphine consumption can be used as an
approximate measure of the availability of
pain control and hence availability of this
form of palliative care.
• Developing countries consumed only 6% of
global consumption of morphine. ( almost
80 percent of the world's population)
• While 10 countries together accounted for
87% of total world consumption of morphine.
International Observatory on End of Life Care