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GENERAL ONCOLOGY AND PALLIATIVE MEDICINE

GENERAL ONCOLOGY AND PALLIATIVE MEDICINE. - Qamar Abbas Deputy Medical Director. PALLIATIVE CARE.

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GENERAL ONCOLOGY AND PALLIATIVE MEDICINE

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  1. GENERAL ONCOLOGY AND PALLIATIVE MEDICINE - Qamar Abbas Deputy Medical Director

  2. 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, social, psychosocial and spiritual. Cancer pain relief and palliative care. Geneva; World Health Organization: 2002 St Clare Hospice

  3. End of Life Care Transition to palliative care Diagnosis Death Specific disease treatment Bereavement support Palliative care

  4. End of Life Care Transition to palliative care Diagnosis Death Specific disease treatment Bereavement support Palliative care

  5. End of Life Care “condition” time

  6. TRANSITION AND DECISION-MAKING • Systematic review (Schofield et al, Palliative Medicine 2006) • Define an optimum model for transitions to a palliative care approach in cancer. • Several steps identified to initiate a discussion • Recognised that evidence of practice in this area is sparse. St Clare Hospice

  7. St Clare Hospice

  8. TRANSITION AND DECISION-MAKING • Will you be surprised if the patient dies within a year? St Clare Hospice

  9. A 94-year old male, thin and frail, has a history of lung injury from tuberculosis he contracted during 27 years in prison. • Has been hospitalized four times in six months for last 3 years (average – total 15 admissions) • Most recently in April when he got fluid from his lungs drained. • Recurrent pneumonia and is now in the hospital again. • He has been there for four days • ? Ventilator St Clare Hospice

  10. St Clare Hospice

  11. BARRIERS • Hope that the patient may get better • No definitive diagnosis • Pursuance of unrealistic or futile interventions • Disagreement about the patient’s condition • Failure to recognise key symptoms and signs • Lack of knowledge on how to prescribe St Clare Hospice

  12. BARRIERS • Poor ability to communicate with patient and carers • Concerns about withdrawing or withholding treatment • Fear of foreshortening life • Concerns about resuscitation • Cultural and spiritual barriers • Medico-legal issues St Clare Hospice

  13. LAST OPPORTUNITY • Finish our business • Create final memories • Give final gifts • Achieve spiritual peace • Say good-bye St Clare Hospice

  14. IF NOT DONE WELL • Patient and carers unaware that death is imminent • Patients loses trust as their condition deteriorates • Patient and carers get conflicting messages • Uncontrolled symptoms leading to distressing death • Dissatisfaction • CPR may be inappropriately initiated • Cultural and spiritual needs not met • Issues in bereavement St Clare Hospice

  15. INDICATORS TO IDENTIFY A PALLIATIVE CARE PATIENT • Progressive deterioration in performance scale (ECOG Scale 3 or 4) • Dependence in 3 or more activities of daily living • Multiple co-morbidities • Symptoms that cannot be alleviated by treating underlying disease St Clare Hospice

  16. INDICATORS TO IDENTIFY A PALLIATIVE CARE PATIENT • Signs of malnutrition due to illness – cachexia; albumin <25g/l • Severe progression of illness over recent months St Clare Hospice

  17. TRANSITION • Identifying curative vs Palliative intent • Improve communication skills • Enhance participation of patient/relative in medical decision-making • Integrative model of healthcare system ranging from active treatment modalities to palliative care setup • Identify medical, social, cultural, and geographic hurdles in developing palliative care St Clare Hospice

  18. St Clare Hospice

  19. SKILLS USED IN PALLIATIVE CARE • Knowledge of diseases and their progress • Symptom Management • Communication skills (listening) • Empowerment • Self-knowledge • Team membership • Reflection • Empathy • Patience • Courage St Clare Hospice

  20. St Clare Hospice

  21. The End of Life Care Pathway

  22. USEFUL TOOLS • Goldstandards Framework • Preferred Priorities of care • Advanced Care Planning • Liverpool Care Pathway St Clare Hospice

  23. REFERRAL TO SPECIALIST PALLIATIVE CARE • Progressive incurable disease or the patient has refused treatment if competent to do so • Prognosis is less than a year (Surprise question: ‘Will you be surprised if patient were to die within one year.’) • Complex symptoms e.g., pain, vomiting etc., where 1st line treatment was instigated but has not helped. St Clare Hospice

  24. REFERRAL TO SPECIALIST PALLIATIVE CARE • Patient is in terminal phase and staff needs support/education • Complex psychosocial/Spiritual/Bereavement issues  • The patient agrees to referral to the palliative care team if competent to choose St Clare Hospice

  25. QUESTIONS? St Clare Hospice

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