Cancer Burden: Global Picture. Number of New Cancer Cases (In Millions)

Lesson 1: Basic Concepts and 5.
Family – Whomever the person says is

Principles of Hospice Palliative Care his or her family. The family may include
relatives, partners, friends and pets.
What is Palliative Care? 6. Grief – Reactions (physical, emotional,
behavioral, spiritual) experienced in
Palliative care is an approach to care which anticipation of, during and after a loss.
improves the quality of life of patients and 7. Needs – Issues that patients and
their families facing the problem associated caregivers mutually agree require attention
with life- threatening illness, through the in the plan of care.
prevention and relief of suffering by means
of early identification and impeccable NEED OF PALLIATIVE CARE
assessment and treatment of pain and
other problems, physical, psychosocial and Cancer burden: Global picture.
spiritual problems. - (World Health Number of new cancer cases (in millions)
Organization, 2016)
Palliative care
- ‘to mitigate the sufferings of the
patient, not to effect a cure’-
Macpherson, 2002.
- Any form of medical care or
treatment that attempts to reduce DEATH AND DYING
the severity of symptoms of a • A person is regarded as dead when
disease rather than stopping or his or her physiological processes
delaying or truing to cure it. have stopped:
- It is aimed at relieving suffering and • WHEN THE HEART HAS STOPPED
improving the quality of life for BEATING
people who are seriously ill. • WHEN BREATHING HAS
STOPPED
TERMINOLOGIES • NO LONGER REGISTERS BRAIN
ACTIVITY
1. Autonomy – the state of being self- • Death has negative connotation for
governed (CPCA, 2001).Thinking and most people.
acting independently without outside • Fear of physical suffering
influence and direction. • Fear of isolation and loneliness
2. Bereavement – the state of having • Fear of nonbeing
suffered the death of someone significant • Fear of cowardice and humiliation
(CPCA,2001) • Fear of failing to achieve important
3. Caregiver goals:
- Anyone who provides care. • Fear of the impact of death on those
- Caregivers are willing to listen to ill who outlive you
persons and responds to their individual • Fear of the death of others:
experiences (Twycross R 2003).
- Formal caregivers are members of an GRIEF AND LOSS
organization and accountable to defined
norms of conduct and practice. • Loss is a universal experience that
- They may be professionals, support occurs throughout the lifespan.
workers, or volunteers. • Grief is a form of sorrow involving
- Informal caregivers are not members of feelings, thoughts and behaviors
an organization. They [usually] do not have caused by bereavement.
formal training and are not accountable to • Responses to loss are strongly
norms of conduct or practice. They may be influenced by one’s cultural
family members or friends (CPCA, 2001). background.
• The grief process involves a
4. Dignity – To treat individuals with sequence of affective, cognitive and
respect, esteem and regard psychological states as a person
responds to and finally accepts a • Physical wellbeing: Free of pain and
loss. discomfort, functional ability etc.,
LOSS = something of value is gone • Psychological well being: free from
GRIEF = total response to emotional anxiety/fears, ability to experience
happiness etc.,
experience related to loss
• Social well being: Purposeful life role,
BEREAVEMENT = subjective response to free from financial burden.
by loved ones • Spiritual well being: feelings of hope,
MOURNING = behavioral response meaning to life.
STAGES OF DEATH AND DYING
KUBLER- ROSS STAGES OF DYING
STAGES OF DEATH AND DYING
Lesson 2: Essential components of

palliative care
• According to Kübler- Ross, these

stages do not always occur in the
same sequence.
• They may overlap.
• Not all individuals experience all the
stages
• Culture, personality traits and a
personal philosophy influences
people’s reactions
What does Palliative Care Provide to the

Patient?
Holistic approach:
• Holistic means the patient is viewed as a
person with Physical, psychological,
social, spiritual and cultural gifts and
needs which are special to that person.
Each of these aspects must be taken COMPONENTS OF PALLIATIVE CARE
into account. (Anne Merriman, 2006)
• The team takes a holistic approach, • Symptom control
using the different talents in a team to • Effective communication
assist in various aspects of the illness. • Rehabilitation
• Reflects whole aspects care. It • Continuity of care
combines the humanistic approach with • Terminal care
a scientific approach. • Support in bereavement
• Education
• Research 3. 3. Emotional and spiritual support is
important for both the patient and family
GOALS OF PALLIATIVE CARE in dealing with the emotional demands
- Palliative care is still sometimes defined of critical illness.
as solely being for people with cancer,
but palliative care is more often now
defined as being for people facing a life- ATTRIBUTES
threatening illness.
- Palliative care is not usually defined as • Individualized patient care
being for people with chronic diseases • Support for the family
such as diabetes. • Interdisciplinary teamwork
• Trust
- Palliative care focuses on symptoms
• Safety
such as pain, shortness of breath,
• Effective Communication
fatigue, constipation, nausea, loss of
appetite, difficulty sleeping and
depression. It also helps you gain the
strength to carry on with daily life. It
improves your ability to tolerate medical
treatments. And it helps you have more
control over your care by improving
communication so that you can better
understand your choices for treatment.
A PALLIATIVE APPROACH
Aims:
• to improve the quality of life for
individuals with a life-limiting illness and
their families, by reducing their suffering
through early identification, assessment
and treatment of pain, physical, cultural,
psychological, social and spiritual needs
SERVICES PROVIDED BY PALLIATIVE CARE
• 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 equipment's and
supplies.
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
Lesson 3: Core Aspects of Hospice
collaborate to identify the sources of
Palliative Care
pain and relieve them with drugs and
other forms of therapy
Philosophy of Palliative Care
2. Symptom management involves treating
symptoms other than pain such as
• To give people with life limiting
nausea, weakness, bowel and bladder
illnesses a reason to hope and a feeling
problems, mental confusion, fatigue,
of greater self-confidence and dignity.
and difficulty breathing
• Embrace a holistic approach to care • Respect the likes and dislikes, goals
giving. choices of the dying person .
• Creating an environment that nurtures • Integrates the psychological and
the physical, intellectual, social and spiritual aspects of patient care.
spiritual well-being. • Offers a support system to help patients
• Recognizes that death is a normal part live as actively as possible until death.
of life and strives to prepare patients • Patient centered rather than disease
and their families focused.
• Practitioners reduce the burden on • Concerned with healing rather than
family caregivers. curing.
• Affirms life & regards dying as normal
Proposed Norms of Practice for process i.e as a part of the life cycle.
Hospice Palliative Care
• Accessis Foundational
• Care is Patient-Focused
• People Have the Right To Choice
• Dying is Part of Life
• Quality of Life Guides Decisions
• Teamwork Is Essential
• Service is Coordinated
• Accountability is Demonstrated Through
Outcomes
• Confidentiality is Central
• Care Setting Is Important
• Caregiver Well-Being Is Fundamental
• On-going Education is Essential
• Research Leads to Advancement in
Care
• Resources Influence Program Quality
• Collaborative Leadership is
Advantageous
SCOPE OF PALLIATIVE CARE PALLIATIVE CARE TEAM
 Palliative care is the specialized medical  Potential members of the

care for people with serious illness. interdisciplinary team for a palliative
 Provides relief from pain, shortness of approach may include but not be limited
breath, nausea and other distressing to:
symptoms. 1. Care assistants
 Affirms life and regards dying as a 2. General Practitioners
normal process. 3. Generalist nurses
 Intends neither to hasten nor to 4. Specialist nurses
postpone death. 5. Aboriginal health workers
 Integrates the psychological and 6. Trained volunteers and their
spiritual aspects of patient care. coordinators
 Offers a support system to help patients 7. Pharmacists
live as actively as possible; 8. Chaplains/pastoral care workers
 Offers a support system to help the
family cope;  Recreation activity officers
 Uses a team approach to address the 1. Pain specialists
needs of patients and their families; 2. Allied health practitioners
 will enhance quality of life; 3. Specialist physicians
 Is applicable early in the course of 4. Community/palliative services
illness, in conjunction with other 5. Psychologists/psychiatrists
therapies that are intended to prolong 6. Specialist palliative service providers
life, such as chemotherapy or radiation managers
therapy. 7. Home attendants
8. Physical, occupational, art, play, music
AIMS AND PRINCIPLES OF PALLIATIVE therapist.
CARE 9. Bereavement coordinators
WHO CAN RECEIVE PALLIATIVE CARE?
• Advanced cancer
 Advanced diseases with poor prognosis
 Severe cortical dementia or change in
mental status
 HIV or AIDS
 Patient, family or caregiver’s stress
 Uncertain goal of care
PRE-HOSPICE CRITERIA FOR PALLIATIVE

CARE-Clinical Indicators
 Frequent trips to the E.D. or the hospital
 Frequent Infections
 Weight Loss
 Changes in intake
 Frequent medication changes
 Falls
 Changes in mental status
 Frequent skin breakdown
 Labile blood glucose readings
 Frequent IV sticks for lab orders
 Pain Issues
 Shortness of Breath
 Patient verbalizes desire to minimize
treatments, trips to the ER.

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Lesson 1: Basic Concepts and 5.

Family – Whomever the person says is

STAGES OF DEATH AND DYING

KUBLER- ROSS STAGES OF DYING

STAGES OF DEATH AND DYING

Lesson 2: Essential components of

• According to Kübler- Ross, these

What does Palliative Care Provide to the

SERVICES PROVIDED BY PALLIATIVE CARE

• Interdisciplinary team care- nursing

Palliative Care Patient Support Services

Three categories of support:

1. Pain management is vital for comfort

SCOPE OF PALLIATIVE CARE PALLIATIVE CARE TEAM

 Palliative care is the specialized medical  Potential members of the

PRE-HOSPICE CRITERIA FOR PALLIATIVE

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