Palliative unit 0 Flashcards
Definition of Palliative
mproves the quality of life of patients and their families facing the problem associated with a 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
Palliative care concepts (8)
Provides relief from pain and other distressing symptoms
Affirms life and regards dying as a normal process
Intents neither hasten nor postpone death
Applicable early in the early stage of illness
Integrates psychological and spiritual aspect of patient care
Support patient to live as actively as possible until death
Support family to cope during patient’s illness and their own bereavement
Is applicable early in the course if illness, in conjunction with other therapies
Defintion of End of Care life
Care given to people who are near the end of life and have stopped treatment to cure or control their disease.
End-of-life care includes physical, emotional, social, and spiritual support for patients and their families.
The goal of end-of-life care is to control pain and other
symptoms so the patient can be as comfortable as possible.
End-of-life care may include palliative care, supportive care, and
hospice care
Definition of Terminally Ill
Life expectancy of 6 months or less
Hospice
a place where a warm feeling between
the host and guest experienced
Eastern Cooperative Oncology Group (ECOG)
Scale used to assess performance status and
determine future treatment options.
ECOG performance status
Refer to Slide
types of Palliative and Hospice Care Services
(Singapore)
Hospital Palliative Care Services
Subacute Palliative Care Services
Inpatient Hospice Services
Palliative Day Care Services
Home Hospice Services
Caregiver Services
Hospital Palliative Care Services
symptoms control, psychosocial and spiritual support; and end-of-life care
Subacute Palliative Care Services
patients with life-limiting illnesses, who require a period of hospitalization for subacute treatment (e.g. complex wound care or symptom control).
- Example: AMK Thye Hua Kwan Hospital, Yishun Community Hospital
Inpatient Hospice Services
patients with life-limiting illnesses, with prognosis of less than 3 months.
When care at home becomes difficult, option of inpatient hospice can be considered.
- Pain and symptom control, Psychosocial and spiritual support, respite Care and end of life care
- Example: Assisi Hospice, Dover Park Hospice, Bright Vision Hospital, St. Joseph’s
Home
Palliative Day Care Services
patients who are diagnosed with life-limiting illness but are stable
and slowly deteriorating. Patients go to day hospice in the day and
return by evening. Meals and transport are provided for a small fee.
Physiotherapy, occupational therapy, art/music therapy; recreational activities (e.g. music, art and art, grooming, cooking, outings); pain
and symptom control; psychosocial and spiritual support; respite care
in the day.
- Example: Assisi Hospice, HCA Hospice
Home Hospice Services
patients diagnosed with life-limiting illnesses and have caregivers at home.
Home visits are conducted by doctors, nurses, counsellors/medical social workers and therapists.
Frequency of visits depends on clinical needs.
Caregiving is done by patient’s caregivers, not the home hospice team.
- Pain and symptom control; psychosocial and spiritual support; end-of-life care; caregiver training; equipment loan; 24hour coverage with hotline and after office hours visits as needed.
- Example: HCA hospice, Dover Park Home Care, Agape Care, Singapore
Cancer Society Home Care, Assisi Hospice
Caregiver Services
Caregiver training and grant; counselling; bereavement support
Concepts of Palliative and End-of-life Care
- Interdisciplinary involvement (10)
Doctor
* Nurse
* Medical Social Worker/ Counselor
* Therapist – Speech, Occupational Therapist,
Physiotherapists
* Pharmacist
* Dietician
* Music, Art Therapist
* Complementary/Alternative Therapy
* Religious representatives
* Caregivers/family members
Patient ->
- Symptom control
- Disease management
- Psychosocial and
spiritual care
Palliative and End-of-life Care, care plan should include (5)
Pain and other symptoms management
Psychological and psychiatric issues assessment and management
Social needs of patients and family members
Spiritual, religion and existential aspects of care
Culture-specific needs of patient and family
Palliative and End-of-life Care
Comprehensive interdisciplinary assessment of the patient and
family members
Respect patient’s goals, preferences and choices (within the limit of ethical and legal boundaries)
Recognize the signs and symptoms of impending death
Concepts of Palliative and End-of-life Care
Respect Patient’s Goals, Preferences and Choices
- Advanced Care Planning (ACP)
- Disease Specific
- Preferred Plan of Care (PPC)
Illness
Trajectories
Refer to slides
ECOG GRADE 0
Fully active, able to carry on all prediseases performance without restriction
ECOG GRADE 1
Restricted in physically strenuous activity but ambulatory and able to carry out any work activities; up and about more than 50% of waking hours
ECOG GRADE 2
Ambulatory and capable of all self-care but unable to carry out any activities; up and about more than 50% of waking hours
ECOG GRADE 3
Capable of only limited self care , confined to bed or chair more than 50% of working hours
ECOG GRADE 4
Completely disabled, cannot carry on any self-care, totally confined to the bed or chair
ECOG GRADE 5
Dead
