Hospice and Palliative Care
Dr. Hadi Awad Hmoud
MB.Ch.B, FICMS-S, MRCS-Ireland, LMCC-Canada
Why we need Hospice or palliative
What palliative care means
Obstacles for palliative care.
Which on is superior to other
Death is inevitable, it is rather a normal
Death does not always mean staff failure.
Sometimes we unnecessarily waist our
resources to prolong life.
Most patients fear not from death itself,
but from the way of their death.
Patient wants to die in peace NOT in
Care must be offered for dying patient and
1-Are we meeting our dying patients’
and caregivers’ demands, like Good
Death (comfortable and suffering free),
Truth Telling, Good Quality of Life,
Good place for death.
2-Are we trained or willing to do so?
3-Are we equipped with tools of doing
4-Are these demands unreachable?
The Nature of Suffering
and the Goals of Medicine
The relief of suffering and the cure of disease
must be seen as twin obligations of a medical
profession that is truly dedicated to the care
of the sick. Physicians’ failure to understand
the nature of suffering can result in medical
intervention that , not only fails to relieve
suffering but becomes a source of suffering
Cassell, Eric NEJM 1982;306:639-45.
Symptoms at the End of Life:
Cancer vs. Other Causes of Death
Pain 84% 67%
Trouble breathing 47% 49%
Nausea and vomiting 51% 27%
Sleeplessness 51% 36%
Confusion 33% 38%
Depression 38% 36%
Loss of appetite 71% 38%
Constipation 47% 32%
Bedsores 28% 14%
Incontinence 37% 33%
Seale and Cartwright, 1994
Cure vs. Palliation
Hope is eradication of disease.
Cure costs sacrifices.
Hope is comfort.
Any intervention that relieves
suffering is acceptable
How could we assess the patient’s
OLD MODEL OF CARE
(Cancer, CHF, COPD, AIDS,
Neurological diseases …)
Most Recent MODEL OF CARE
is specialized medical care for
people with end-stage illnesses. It
focuses on relieving suffering and
improving quality of life, regardless of
It strives to focus on both the
patient and the family (Caregivers).
It is provided by a multidisciplinary
team of doctors, nurses, and other
specialists to provide efficient
It helps patients and their families in
navigating the healthcare system.
It offers guidance for difficult and
complex treatment choices.
It provides emotional and spiritual
support for patients and their families
Indeed we barely made it touchable
Obstacles for palliative care
Delay of the decision making .
Social and cultural issues.
Shortage of facilities.
Opiate especially Morphine restriction:
morphine is not readily available across
the country. It is recommended to be
given frequently and extended to a long
Lack of trust between staff and
Patient and family education
including other caregivers.
Education and training of palliative
care for medical staff, particularly
physicians and nurses is not
Blue: Surveyed, Red: Officially registered
Rate and type of malignancies in Basra in 2008
Good Palliation Indicator
Morphine consumption can be used as an
approximate measure of pain control and
hence success of this form of palliative
Developing countries consumed only 6%
of global consumption of morphine. (almost
80 percent of the world's population)
10 countries together accounted for 87% of
total world consumption of morphine.
International Observatory on End of Life Care
Average daily consumption of defined daily doses (for statistical purposes)
of morphine per million inhabitants, 2000-2002
Source: International Narcotics Control Board Narcotic Drugs: Estimated World Requirements for 2004.
Statistics for 2002. New York: United Nations, 2004.
A limited range
Is specialized care for patients who
have been given a terminal diagnosis
with a grief prognosis.
Offers care for the whole person,
focusing on pain and symptom
management, psychological, social,
and spiritual care. Hospice seeks to
relieve suffering while focusing on
dignity and quality of life.
It is a support to patients and
family members throughout the dying
It offers bereavement follow up for
primary caregivers and family
It is an appropriate opportunity for
patients to meet those who shared
them the sufferings
It is done in purposeful founded
Which one does work better for Iraq
Personaly I believe that Hospice is superior to
Palliation for these reasons:
1-It minimizes the Cost on family.
2-It is suitable for our low educated society.
3-It mininmizes the burden of relentless seek
4-Cost-effective for the budget and resources.
Elderly Palliative care, the right to quality of lifeElderly Palliative care, the right to quality of life