Palliative Care Flashcards
1
Q
Learning Objectives
A
- Overview of the global provision of palliative care
- Analysis of challenges of providing palliative care to both CD and NCD populations
- Examining palliative care services in diverse populations
2
Q
What is the WHO’s definition of Palliative care?
A
- WHO definition:
- ‘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’
3
Q
What is the new definition of Palliative care?
A
- Palliative care is the active holistic care of individuals across all ages with serious health-related suffering due to severe illness, and especially of those near the end of life. It aims to improve the quality of life of patients, their families and their caregivers.
- Suffering is health-related when it is associated with illness or injury of any kind.
- Suffering is serious when it cannot be relieved without medical intervention and when it compromises physical, social, spiritual, and/or emotional functioning.
- ‘‘Serious illness is a condition that carries a high risk of mortality, negatively impacts quality of life and daily function, and/or is burdensome in symptoms, treatments, or caregiver stress”.
4
Q
What are the features of Palliative care?
A
- Includes, prevention, early identification, comprehensive assessment and management of physical issues, including pain and other distressing symptoms, psychological distress, spiritual distress and social needs. Whenever possible, these interventions must be evidence based.
- Provides support to help patients live as fully as possible until death by facilitating effective communication, helping them and their families determine goals of care.
- Is applicable throughout the course of an illness, according to the patient’s needs.
- Is provided in conjunction with disease modifying therapies whenever needed.
- May positively influence the course of illness.
5
Q
What does palliative care also include?
A
- Intends neither to hasten nor postpone death, affirms life, and recognizes dying as a natural process.
- Provides support to the family and the caregivers during the patient’s illness, and in their own bereavement.
- Is delivered recognizing and respecting the cultural values and beliefs of the patient and the family.
- Is applicable throughout all health care settings (place of residence and institutions) and in all levels (primary to tertiary).
- Can be provided by professionals with basic palliative care training.
- Requires specialist palliative care with a multiprofessional team for referral of complex cases
6
Q
Which 2 options can a person at the end stages of life take?
A
- Curative care
- Palliative Care
7
Q
Describe the concept of total pain
A
- Dams Cicely Saunders 1664
- Physical symptoms
- Mental distress
- Social problems
- Emotional problems
8
Q
Describe palliative care for CD’s and NCD’s
A
- Different illnesses have different patterns of symptoms and illness trajectories
- This creates difficulties for defining who the populations that might benefit are, and when to start the provision of palliative care
9
Q
What are the 3 main trajectories of decline at the end of life?
A
- Number of deaths in each trajectory, out of the average 20 deaths each year per UK General practice list of 2000 patients
- Cancer
- Organ Failure
- Physical and cognitive frailty
- View diagram to see graph
10
Q
What is Qaly and Daly?
A
- QALY – Quality-Adjusted Life Years
- Measures both quantity and quality of life.
- A QALY of 1 = 1 year of perfect health.
- In palliative care, it helps evaluate whether treatments improve quality of life (e.g., pain relief, symptom management).
- DALY – Disability-Adjusted Life Years
- Measures the burden of disease by combining:
- Years of Life Lost (YLL) due to early death.
- Years Lived with Disability (YLD) due to illness.
- More commonly used in public health to assess overall disease impact, rather than focusing specifically on palliative care.
11
Q
What are the problem with Qaly and Daly?
A
- Measuring impact of palliative care is difficult
- Can you work out the Qaly impact
- Validates scales are key
- Always check, Have the scales been validated in the setting they are used in?
- African APCA POS
12
Q
List some numbers of palliative care
A
- 61 million people experienced SHS in 2015.
- 25.5m of them died (45% of total deaths)
- Half of adults, and a third of children occurred in LMIC’s
- 81% of SHA associated deaths occurred in LMIC’s
- 48 million will die with SHS by 2060, 83% in LMIC’s, 155% rise in LIC’s
- The highest proportion (78%) of adults in need of palliative care at the end of life live in low and middle-income countries, but the highest rates are found in the higher-income groups.
- 98% of children requiring palliative care are in low and middle-income countries.
13
Q
What are the statistics of paediatric palliative care in need?
A
- Global Survey 2014-2015:
- Need for children’s palliative care ranged from almost 120 per 10,000 children in Zimbabwe to slightly more than 20 per 10,000 in the United Kingdom.
- Over 21 million with conditions that will benefit annually from a palliative care approach
- 8 million need specialized children’s palliative care
14
Q
What is the need of palliative care on a local scale?
A
- 46% of inpatients in a point prevalence survey in Mulago Hospital, Kampala had an active life limiting disease (68% of medical inpatients).
- Harding et al - 112 patients - mean number of symptoms was 18 (SD = 6.6).
- The five most prevalent symptoms were pain (87.5%), lack of energy (77.7%), feeling sad (75.9%), feeling drowsy (72.3%) and worrying (69.6%).
15
Q
What was the statistics form Senegals Teritiary hospital?
A
- 376 inpatient files viewed
- 44.4% were found to have an active life limiting illness
- Four disease groups made up of 78.6%
- Cancer (32.9%)
- Stroke (19.8%)
- Chronic heart failure (18%)
- HIV (7.9%)
16
Q
The global provision
A
VD
17
Q
Models of Care
What does this provision look like?
A
- UK
- Uganda
- Kerala, India
18
Q
Describe the models of care in the UK
A
- Hospital, hospice and homecare teams
- NHS and third sector funding
- Specialist inpatient beds – usually in hospices
- Specialist home care teams
- Specialist support to existing homecare teams, eg social care, District nurses, GP’s etc
- Recognised medical speciality by Royal College of Physicians
19
Q
Describe the models of care in Uganda
A
- Hospice (Africa) Uganda
- Commenced in 1993 by Professor Anne Merriman (UK)
- Model Hospice Care for Africa
- Patients with Cancer and/or HIV/AIDS primarily
- Home based care – no inpatients
- Weekly review patients within 20km radius
- Mobile Clinics
- In-reach to teaching hospitals
- Education – health professionals and non-health professionals
20
Q
Describe the models of care in Kerala India
A
- With only 3% of India’s population, the tiny state provides two-thirds of India’s palliative care services.
- Formal state palliative care policy, state funding
- The state relaxed narcotics regulations to permit use of morphine by palliative care providers
- Volunteers deliver services to patients who largely remain in their own homes.
- Case finding and trained to deal with social, spiritual and financial issues.
21
Q
What was the Sphere guidelines for Palliative care and communicable diseases in 2018?
A
- Clinical standard 2.7: Palliative Care
- ‘People have access to palliative and end-of-life care that relieves pain and suffering, maximises the comfort, dignity and quality of life of patients, and provides support for family members’
- New to the 2018 guidelines
22
Q
Who should provide the sphere guidelines for 2018?
A
- International NGO’s
- Local NGO’s
23
Q
List a few barriers to these guidelines?
A
- Resource Allocation
- Lack of clear policies
- Lack of palliative care skillset
- Lack of access to opioids*
- Patterns of neglected suffering – ‘tyranny of low expectations’
- Based in wider inequalities
24
Q
List some mechanisms for the adapting models?
A
- Pain
- Dry mouth
- Mobility problems
- Feeling worried / anxious
- Constipation
- Change in appearance
- Anorexia
- Hunger – 70% report this in Uganda*
- Neuropathy
- Muscle aches
25
How is the severity of pain measured?
Through rating scales
26
What is meant by culturally appropriate palliative care?
- “Good death” – many meanings
- The clinical role / attitude
- cure not care
- lack of disclosure to patient
- bearer of bad news may cause terminal illness
- Family vs patient decision making
- Meaning of disease
- cause of disease - local or orthodox illness?
- Place of Care / Death
27
Conclusion
- Definitions of palliative care remain controversial
- High levels of need
- Global coverage is poor
- Migrant and refugee populations especially underserved
