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The Basics of Palliative Care Models of Care and Settings of Care

Explore the significance of palliative care as a public health issue, prevention model, and specialized care for various patient populations like cancer, HIV/AIDS, and TB. Learn about the diverse care models and settings worldwide.

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The Basics of Palliative Care Models of Care and Settings of Care

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  1. The Basics of Palliative Care Models of Care and Settings of Care Kathleen M. Foley, MD October 26,2011 Brasov, Romania

  2. 2002 WHO Definition of Palliative Care "Palliative care is an approach which improves quality of life of patients and their families facing 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. Palliative Care as a Public Health Issue • affects all people • need for better information on end-of-life care • potential to prevent suffering • potential to prevent disease

  4. Palliative Care as a Prevention Model • prevents needless suffering • provides peer education • provides patient centered care • incorporates self-management programs

  5. UNAIDS Report • 40 million living with HIV/AIDS -28.5 million in sub-saharan Africa • 14 million orphans worldwide -11 million in sub-saharan Africa • 20 million have died since 1981

  6. Global Cancer Mortality 12.7 million patients diagnosed each year with cancer 7.6 million who die from cancer 29 million cancer survivors

  7. Global Cancer Mortality (millions/yr) Data Source: World Bank

  8. Tuberculosis Global Facts • In 2009: • 9.4 million new TB cases in 2009 • 1.7 million people died from TB in 2009 • 440,000 new MDR-TB cases • 150,000 deaths from MDR-TB

  9. Pediatric Palliative Care Worldwide there are 7-9 million children with life-limiting and life-threatening conditions requiring palliative care 80% live in resource-limited countries

  10. Patient Populations Requiring Palliative Care Cancer Patients HIV/AIDS Patients Patients with MDR-XDR TB Frail Elderly patients with multiple comorbidities Patients with neurodegenerative diseases

  11. The continuum of palliative care Life Closure Therapies to modify disease(curative, restorative intent) Actively Dying Death Diagnosis 6m BereavementCare Therapies to relieve suffering, improve quality of life

  12. WHO Public Health Model Policy Outcomes Context DrugAvailability Education Implementation

  13. Settings of Palliative Care Hospital Home Nursing Home/Rehabilitation Unit Pediatric Home Hospice Home

  14. Models of Care Hospital- based palliative care ICU Cancer unit Neurologic unit Neonatal unit Home-based palliative care Nursing home palliative care Free standing hospice

  15. Specific Resources / settings Hospices Acute Hospitals Mid term and long term, RHB, (Sociohealth Centers) Nursing homes Units Support teams Outp’s / Day care Community / home

  16. Types of services and Levels of complexity Reference: complexity+ training+ research Complete teams Units Basic suport teams (home, hospitals, comprehensive) Transitional measures: individual Specialist nurses or consultants General measures in conventional Services (Hospitals, Primary care, Nursing homes, Emergencies, etc)

  17. Standards of specific resources • 1 supportteam at home / 100.000 h • 80-100 beds/milion habitants • (10-20% acute, 40-60% midterm, 20-30% nursing homes) • 20-25 full time doctors / milion habitants • 1 teamavailable in every hospital (units in teaching) • Models of organization adapted to demographic scenarios: metropolitans, intermediate, or small sectors < 100.000 • Models in specificresources(cancerinstitutes, nursinghomes, etc) XGB 2005, WHOCC, 2008

  18. Regional variations *A service here is defined as a service type: number of services courtesy of EAPC Task Force

  19. Implementation strategies of services:initial phases To create a nucleus of solid experiences Combine different types: home, hospital, cancer, geriatric,…. Based in feasibility: active leaders, institutional comittment, …. Cathalitic measures: support teams, transitional, … Define services before starting implementation

  20. Models of organisation in demographic and geographic scenarios

  21. Rural Urban Rural-urban Metropolitan Demographic and settingscenarios • Settings • Demographic Adapt the organisation to needs and contexts Primary/community care Nursing homes Longterm / intermediate Hospitals: district general, university Cancer Institutes

  22. . The ‘Qualy’ End of Life Care Observatory WHO Collaborating Centre for Public Health Palliative Care Programmes whocc.info@iconcologia.net +34 93 260 77 36 Institut Català d’Oncologia ICO l’Hospitalet Hospital Duran i Reynals Gran Via de l’Hospitalet, 199-203 08908 l’Hospitalet de Llobregat

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