This document discusses the basic principles of palliative care, including definitions, goals, ethical issues and barriers. It provides statistics on palliative care needs in Palestine, including causes of death, cancer rates and lack of services. Recommendations are made to establish national palliative care policies and programs, train healthcare workers, ensure availability of pain medications, and incorporate palliative care into existing healthcare systems to improve end of life care.
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Palliative care is an approach to care which improves the quality of life of patients and their families facing the problem associated with life-threatening illness.
Through palliative care, we change the role of a patient into a whole human being.
Through palliative care, we transform the stages leading to death into times filled with life
Palliative care is an approach to care which improves the quality of life of patients and their families facing the problem associated with life-threatening illness.
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Children are given palliative care in tertiary hospitals and even at home also. This topic includes which are the pediatric conditions require palliative care and what are the common symptoms children are facing and how to manage these symptoms.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Presented at Kansas City University of Osteopathic Medicine 10/27/15 in Lecture Series in Bioethics. See live presentation here: https://www.youtube.com/watch?v=Dr3g3PeVKeo
Dr. Elizabeth Paulk gives an excellent review of palliative care topics including end of life discussions, hospice, pain management, and family counseling.
Children are given palliative care in tertiary hospitals and even at home also. This topic includes which are the pediatric conditions require palliative care and what are the common symptoms children are facing and how to manage these symptoms.
Medication non-adherence is a growing concern, as it is increasingly associated with negative health outcomes and higher cost of care. Tackling the burden of non-adherence requires a collaborative, patient-centric approach that considers individual patient needs and results in intelligent interventions that combine high-tech with high-touch.
Watch the recorded webinar at http://www.mainewellness.org/cannbis_in_cancer_treatment_webinar_recording
From prevention through treatment and remission, cannabis is a powerful tool in the fight against cancer–the government’s National Cancer Institute has even updated its information to reflect the plant’s anti-cancer properties!
Join us and special guest, Molly Stewart, of the Cancer Community Center, for a discussion of the scientifically-proven and real-life benefits of cannabis in cancer treatment, and to learn more about support services and resources for cancer patients and their families.
This ppt is very simple and has immence importance in dispensing pharmacy. it has been prepared based on the syllabus of WBUT & consists of informations of elimentary label...WHAT IS A “PRESCRIPTION” ?
A Prescription is a written order from a Registered Medical Practitioner, or any other Licensed Practitioner, such as Dentists, Veterinarian etc.
ABBREVIATIONS:-
It represents a problem in understanding the parts of a prescribing order & therefore leads to confusion…
NAME OF THE DRUG
There are certain drugs whose name look or sound like those of other drugs…
INSTRUCTIONS FOR THE PATIENTS
It essential to mention the instructions like quantity of the drug to be taken, the frequency & timing of administration in order to avoid confusion…
INCOMPATIBILITIES
It is essential to check that there are no Pharmaceutical or Therapeutic incompatibility in a prescription…
Effective pain management in terminally ill requires
Understanding of pain control strategies
Ongoing assessment
Diagnosis of pain
Breakthrough pain relief
Fine adjustment of medications
Opioid rotation
Unresolved psychosocial or spiritual issue can be great impact to pain management
A brief presentation on medicines optimisation and the input a clinical pharmacist can make in improving treatment outcomes for patients and help make evidence led cost effective improvements for the wider NHS.
June Lee, MD, Director of CTSI's Early Translational Research program, presents the goals and vision for the program. Learn more about June Lee at UCSF Profiles http://profiles.ucsf.edu/ProfileDetails.aspx?From=SE&Person=5208624
Charlie Keller, a primary care physician at Mercy Clinics, Inc. describes Mercy's experience with shared decision making implementation.
This presentation was part of a Shared Decision Making Month webinar -- Shared Decision Making in the Real World: Stories from the Frontline.
CME presentation made on 10th Nov 2012. Discusses a Radiation Oncologist's perspectives of cancer pain management, shortcomings of WHO pain ladder, ASTRO guidelines for metastatic bone pain.
Many questions arise around this topic: What is Artificial Intelligence and what isn't? What is possible today? How can my organisation use AI? Will this replace my job? What can we expect in the future?
We will answer these and more in our presentation. We help you understand the impact of digital on your business and give you concrete steps to start taking action.
The course of death and dying has changed tremendously in the past.docxarnoldmeredith47041
The course of death and dying has changed tremendously in the past few decades because of social and technological advances. Increases in average life expectancy due to advances in medical science and technology (National Center for Health Statistics, 2010) have influenced our beliefs and attitudes about life and death. The course of illness and dying has changed; at one time, the onset of illness and subsequent death from certain illnesses was sudden and rapid, but now the typical death may be more prolonged. The place where death occurs has moved from the home or community to the hospital, nursing home, or institutional setting. These changes have posed enormous challenges in end-of-life and palliative care.
PALLIATIVE CARE
Palliative care is an interdisciplinary care model that focuses on the comprehensive management of physical, psychological, and existential distress. It is defined as “the active total care of patients whose disease is not responsive to curative treatment.” Control of pain and other symptoms and psychological, social, and spiritual problems is paramount. “The goal of palliative care is the achievement of the best possible quality of life for patients and their families” (World Health Organization [WHO], 1990, p. 7). Palliative care aims to improve the patient's quality of life by identifying physical, psychosocial, and spiritual issues while managing pain and other distressing symptoms. Palliative care “affirms life and regards dying as a normal process; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated” (WHO, 2004, p. 3).
The palliative care model applies throughout the entire course of illness and attempts to address the physical, psychosocial, and spiritual concerns that affect both the quality of life and the quality of dying for patients with life-limiting illnesses at any phase of the disease. It includes interventions that are intended to maintain the quality of life of the patient and family. Although the focus intensifies at the end of life, the priority to provide comfort and attend to the patient's and family's psychosocial concerns remains important throughout the course of the illness. In the model's ideal implementation, patient and family values and decisions are respected, practical needs are addressed, psychosocial and spiritual distress are managed, and comfort care is provided as the individual nears the end of life.
Palliative medicine is the medical specialty dedicated to excellence in palliative care. Palliative care specialists, including social workers, typically work on teams and are involved when patients’ disease is advanced, their life expectancy is limited, and medical and psychosocial concerns become complex and more urgent. In practice, these problems ofte.
The course of death and dying has changed tremendously in the past.docxrtodd643
The course of death and dying has changed tremendously in the past few decades because of social and technological advances. Increases in average life expectancy due to advances in medical science and technology (National Center for Health Statistics, 2010) have influenced our beliefs and attitudes about life and death. The course of illness and dying has changed; at one time, the onset of illness and subsequent death from certain illnesses was sudden and rapid, but now the typical death may be more prolonged. The place where death occurs has moved from the home or community to the hospital, nursing home, or institutional setting. These changes have posed enormous challenges in end-of-life and palliative care.
PALLIATIVE CARE
Palliative care is an interdisciplinary care model that focuses on the comprehensive management of physical, psychological, and existential distress. It is defined as “the active total care of patients whose disease is not responsive to curative treatment.” Control of pain and other symptoms and psychological, social, and spiritual problems is paramount. “The goal of palliative care is the achievement of the best possible quality of life for patients and their families” (World Health Organization [WHO], 1990, p. 7). Palliative care aims to improve the patient's quality of life by identifying physical, psychosocial, and spiritual issues while managing pain and other distressing symptoms. Palliative care “affirms life and regards dying as a normal process; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated” (WHO, 2004, p. 3).
The palliative care model applies throughout the entire course of illness and attempts to address the physical, psychosocial, and spiritual concerns that affect both the quality of life and the quality of dying for patients with life-limiting illnesses at any phase of the disease. It includes interventions that are intended to maintain the quality of life of the patient and family. Although the focus intensifies at the end of life, the priority to provide comfort and attend to the patient's and family's psychosocial concerns remains important throughout the course of the illness. In the model's ideal implementation, patient and family values and decisions are respected, practical needs are addressed, psychosocial and spiritual distress are managed, and comfort care is provided as the individual nears the end of life.
Palliative medicine is the medical specialty dedicated to excellence in palliative care. Palliative care specialists, including social workers, typically work on teams and are involved when patients’ disease is advanced, their life expectancy is limited, and medical and psychosocial concerns become complex and more urgent. In practice, these problems ofte.
Table of TablesS. No.ContentsPage No.Table 5-1Name.docxdeanmtaylor1545
Table of Tables
S. No.
Contents
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Table 5-1
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Table 5-2
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Table 5-3
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Table 5-4
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List of Appendixes
No.
Contents
Page No.
Appendix A
Questionnaire
43
Appendix B
Consent Form
44
Appendix C
Declaration Form with your signature
List of Abbreviations
All of the following abbreviations are to be taken in context of the study
A
B
C
Palliative care
terminal illness
Abstract
Background: Palliative care clinical nurse specialists play an important role in specialist palliative care. Nurses perceive palliative care to be the most stressing facet of nursing. This is because it is emotionally draining to see a patient experience immense pain due to the inevitability of their death. Despite the view that palliative care is emotionally straining, it improves the quality of life of patients with terminal illnesses, such as cancer. This form of care also assists families of patients diagnosed with life-threatening ailments or organ failures. This is because palliative care involves early identification, and impeccable evaluation and curing of physical and emotional pain associated with chronic diseases.
Aim of the study: The purpose of this study was to assess nurses’ knowledge, attitude and practices about palliative care, determine the effect of the training program about palliative care on quality of nursing care and Identify factors affecting quality of nurses’ preparedness to practice palliative care in oncology units at King Abdullah specialized children hospital in Riyadh, Saudi Arabia
Subjects and methods: cross sectional study was used for conducting the study, A convenience sample nursing were included from five oncology units
Data collected through; demographic characteristic and PC knowledge and attitude .
Results:
Conclusion:
Chapter One
Introduction
Introduction
Everyone is mortal; hence, death is an inevitable phenomenon that affects every person across the globe. Nurses play a critical role in the beginning and ending of individuals’ lives as they are present at birth and dying moments. Many nurses play a vital role in caring for individuals who are in their final days on the world. As such, nurses perceive palliative care to be the most stressing facet of nursing. This is because it is emotionally draining to see a patient experience immense pain due to the inevitability of their death. Despite the view that palliative care is emotionally straining, it improves the quality of life of patients with terminal illnesses, such as cancer. This form of care also assists families of patients diagnosed with life-threatening ailments or organ failures. This is because palliative care involves early identification, and impeccable evaluation and curing of physical and emotional pain.
Running head Identification of Complementary and Alternative Medi.docxcharisellington63520
Running head: Identification of Complementary and Alternative Medicine 1
INTREGRETING HOMEOPATHIC TREATMENT WITH CARE OF CANCER 7
Integrating Homeopathic Treatment with the Care of Cancer
Teresa Campbell
HCS: 321 Foundations of Complementary and Alternative Medicine
Belinda Atchison
August 20, 2015
While In contrast, is their really enough antidotal evidence that suggest complementary and alternative medicine is more effective then mainstream medicine in the treatment of cancer? There is supported evidence that when remedies are properly used in homeopathic care, specific remedies have reversed the growth of cancer. Various forms of homeopathic therapy allow the patient to take control of their health while making small manageable changes without the huge cost. Alternative therapies open new options for patients without harmful side-effects. The interest in preventative health has encouraged society to explore outside of the mainstream field of medicine and the options of various therapies are now being considered. Is it possible for Homeopathic remedies to be the future treatment and care for cancer?
Complementary and Alternative Medicine (CAM)
Protocols
Treating the person and as a whole being (Mind, body and spirit).
The focus on engaging the inner resources of each individual as an active & conscious participate in their own well-being. Complementary and Alternative systems do not research into echelons the practitioner/healer is not above the one that is being healed. The relationship is on a continuum of mutuality where both walk step-by-step on the journey to healing (Koopsen and Young, 2009).
Historical events
Samuel Hahnemann noted the description of a remedy made from "Peruvian Tree Bark" (Cinchona) (Cuellar, 2006. p. 79). Hahnemann’s “The Organon of Medicine” was published from first edition in eighteen ten, and “The Organon of the Healing Art” in nineteen twenty-one which enhanced the influence of homeopathic theory significantly. (Micozzi, M, 2015)
Chronic Disease
Chronic illnesses refer to those illnesses that are usually not fully recovered from them once a person has them. (Burkholder, Nash, 2014). Chronic conditions can remain for life, it is important for those affected by them to understand their condition and related care in order to achieve the highest quality of life. (Eliopoulos, 2014, p.280, para 1)
CAM perspective
The law of Similars, Allow the body to heal itself (Micozzi, 2015, p.385 para, 6). Cam perspective is to define what is causing disharmony in the body, treat it, and then allow the body to heal itself. We live in an era when individuals can survive and have a high quality life being empowered with knowledge, having a support system, and having a positive mind frame. The healing approach is stimulated by information.
Cultural Challenges
Culture includes spirituality and religious practices, which are intimately related to health beliefs and practices, an.
How treating psychological and social needs can improve the daily lives of the chronically ill, creating a new model for outpatient care, quality of life and aging, humanization of care, streamlining responsibilities of hospital staff and news around the world.
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
I didn't know this option of Palliative care existed prior to my mother's passing earlier this year of colorectal cancer. However, I do now know about it and want to share it with all of you
The lecture I gave for the Indiana University Health Joint Transplant Education and Research Lecture Series on palliative care. That's right, palliative care in transplant patients NOT at the end-of-life.
Body Balance "The Holistic Homeostatis" for Instant Pain Relief.SRIKRISHAN Sharma
To promote (SEEEQ) Safety, Education, Efficacy, Efficiency, Quality, of Holistic Health Care Systems through cost effective TCAM, Integrative medicine, Complementary & Alternative medicine, Indigenous, Traditional Medicine and Wellness Services we have designed, promogated and developed wonderful healing system “Body Balance”. The Homeostasis in a general sense which, refers to stability, balance or equilibrium. It is the body's attempt to maintain a constant internal environment which requires constant monitoring and adjustments as conditions change outside the body. This adjusting of physiological systems within the body is called homeostatic regulation. The Most Important in Life e is Balance. Balance of Inner and Outer Side of You. Balance refers to an optimum state of mind between calm and alert.
Sir, with our efforts we have designed unique Balancing System covering all the universal Manipulative and body-based systems are divided into three subcategories; (i) chiropractic, sacrum- spinal manipulation; (ii) massage and body work (osteopathic manipulative therapy. kinesiology, reflexology, Alexander technique, rolling, Chinese tui na massage and acupressure), and (iii) unconventional physical therapies (hydro therapy, colonies, diathermy, light and color therapy. heat and electrotherapy, trigger point therapy). Once the Balance is done pain immediately reduces and “Energy and persistence conquer all things in a Balancing State”.
For the country like India this is unique therapy without any additional burden on the pockets and can be integrated or complemented for both the conventional and indigenous system of medicines. All the existing creed of doctor can be up-graded to this new skill for instant relief & better results.
Similar to Basic Principles In Palliative Care For Ca Pt (20)
1. Basic PrinciplesinPalliative Care Amal Dweib Khleif RN, BSN, ON, Palliative Care Nurse Al-Sadeel Society Palliative Care for Cancer Patients
2. Objective Facts. The professional caregiver attitude. Why we need palliative care. What’s really palliative care mean? Ethical issues. The holistic assessment. The Interdisciplinary Team. Barriers in palliative care. National policy for palliative care. The scientific material was adopted from: the presentation (principles and issues in palliative care) for Abu-Rakiah Riad.
3. FACTS All of us well die. Death does not meaning staff failure. We spend our resources to prolong life.
4. Are we meeting our patients and their families wishes when they enter end of life pathway ?
9. Mechanical medicine, use in the technology and rise in the life expectancy. inappropriate communication between physician and patient and family. inappropriate pain control. Load of symptoms in the end of life . Majority of diagnosed patient are in late stage . Mechanical medicine, use in the technology and rise in the life expectancy.
10. Symptoms at the End of Life: Cancer vs. Other Causes of Death Cancer Others 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
11. 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 itself. Cassell, Eric NEJM 1982;306:639-45.
12. Is really quality of life important? The incidence of death at hospital near 80%
14. New concept THE TERMINALLY PATIENT. SHIFTING THE GOAL OF THE TREATMENT. GOOD DEATH. COMFORT AND SUFFERING. TRUTH TELLING. QUALITY OF LIFE THE PLACE OF THE DEATH.
15. Palliative care Palliative Care is defined by the World Health Organization (WHO) as “the active total care of the patients and their families by a multi-professional team at a time when cure is not an option and life expectancy is relatively short. It responds to physical, psychological, social and spiritual needs, and extends if necessary to support in bereavement.” (WHO1990)
16. Palliative care Treatment approach that improves quality of life of patient and their family members, that deal to the diseases that threaten on life, by prevention and alleviation of the suffering by means of early detection and professional estimation of pain and additional symptoms, bodily psychosocial and spiritual. (WHO 2002)
17. PRINCIPLES provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten nor postpone death; integrates the psychological and spiritual aspects of patient care;
18. PRINCIPLES offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement; distressing clinical complications.
19. PRINCIPLES uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy,
20. OLD MODEL OF CARE ABRUPT TRANSITION TO HOSPICE D I A G N O S I S CURATIVE PALLIATIVE DD DEATH RELIEF OF SUFFERING PROLONGATION OF LIFE
22. Most Recent MODEL OF CARE Continuumof Care Curative Treatment (Cancer, CHF, COPD, AIDS, Dementia debilitating Neurological diseases …) Bereavement Care Hospice Palliative Treatment Diagnosis Death
23. Cure vs. Palliation Cure fundamental hope is eradication of disease assumes cure is worth a sacrifice Palliation fundamental hope is comfort consequences of any intervention that relieves suffering are acceptable
24. How could we assess the patient needs? Holistic : Physical. Psychological. Spiritual. Social.
25. Physical Dimension Performance status (ADL). Symptoms. Nutrition and hydration. Physical safety (falls).
27. Spiritual Dimension Meaning of life and the death . Religious. Meaning of hope. Multiple losses. “The spiritual dimension cannot be ignored, for it is what makes us human.” Victor E. Frankl, Man’s Search for Meaning. New York: Simon & Schuster, 1984:135.
28. Social Dimension Loneliness . Economic (heavy expenses ) . Caregivers and family burden. Support network. House and patient environment . Community environment (Culture, groups of support ).
29. The Interdisciplinary Team Physicians. Nurses . Social worker. Physiotherapist . Volunteers . clinical psychologist . secretary . Clergyman. Pharmacist
30. Barriers in palliative care Delays in the decision making . if it's possible to discuss? (about shifting goals of treatment). Costs. History and tradition (in medicine). Social and cultural issues. Not enough services (palliative care).
31. Barriers in palliative care Indeed, costs spent on curative efforts with minimal results would, if spent on palliative care, have a major positive impact on both patients and their families. Morphine restriction: morphine is not readily available across the country. Opioids prescription is still restricted to 3-10 days. It is recommended to be extended to a month.
32. Barriers in palliative care Trust between staff and family. Patient and family education (other caregivers). Education and training of palliative care for medical staff, particularly physicians and nurses is not available.
33. Morphine consumption can be used as an approximate measure of the availability of pain control and hence availability of this form of palliative care. Developing countries consumed only 6% of global consumption of morphine. ( almost 80 percent of the world's population) While 10 countries together accounted for 87% of total world consumption of morphine. International Observatory on End of Life Care Morphine consumption as indicator of effective palliative service:
34. 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 Morphine Consumption
35. The Triangle shaped project for establishing Palliative Care Program which was developed by WHO. Process measures(foundation): Cost little, but big effects Necessary before outcome measures All three should be done namely: Drug availability Changes in health care regulations /legislation to improve drug availability (especially opioids) Improvements in the area of prescribing, distributing, dispensing, and administration of drugs Education Public Health care professionals (doctors, nurses, pharmacists) Others (healthcare policymakers / administrators, drug regulators Governmental policy National or state policy emphasizing the need to alleviate chronic pain through education, drug availability, and governmental support /endorsement The policy can stand alone, be part of an overall national/ state control program, be part of an overall policy on care of the terminally ill
36. WHY? Do we need palliative care in Palestine? ?
37. Statistics Cause of death 2003 Heart Diseases 20.1% Carebrovascular diseases 11.1% Perinatal conditions 9.7% Cancer 9.0% 5Accidents 8.9% Hypertension 4.9% Diabetes mellitus 4.1% Renal failure 3.4% Source: Ministry of Health
39. Statistics Statistics revealed 5,542 new cancer cases in the WB, and 2,305 deaths 1999-2003, Palestinian National Cancer Registry
40. Statistics Health Services for cancer patients: 75 beds in oncology departments in MOH hospitals. 2.7% of the total number in MOH hospitals beds. 60 beds in daily care departments. Source: Palestinian Health Information Center (PHIC) Ministry Of Health (MOH), 2007
41. Statistics Health Services for cancer patients: Occupancy rate at 231.8% for day care. In developing countries, 80% of breast cancer cases are diagnosed on end stage Source: Palestinian Health Information Center (PHIC) Ministry Of Health (MOH), 2007
42. Statistics Table: Palliation and palliative support available to Palestinians 2005 Source: International Observatory on End of Life Care (IOELC)
43. Statistics Palliative care in Palestine Palliative care remains an undeveloped and under resourced area of healthcare in the Palestinian Authority. lack of palliative care training and the lack of awareness of needs. There is a need for a national programme of palliative care and to have a dedicated society for hospice care. IOELC Questionnaire: February 2004 MECC conference, Larnaca, Cyprus Interview with Dr. Salhab.
44. Statistics Palliative care in Palestine We are in need for: Palliative care medicine; legislations and prices. Multidisciplinary team for cancer care. Hospice program IOELC interview: Dr Fouad Sabatin – 2 May 2005
52. Recommendations We need the government to ensure: National policies and programs for palliative care. Palliative care programs are incorporated in the existing health care systems. Health care workers are adequately trained in palliative care. Availability of both opioid and non-opioid analgesics, and annual estimation of stock.
56. All must die someday. It is not an ‘if’ but a ‘when’, ‘where’ and ‘how’. If death is inevitable, we can only hope for a good death…or perhaps we can try to plan for one. Advance care planning may mean the difference between a good death and abad death
57. We cure seldom palliate often and comfort always (16th Century Anonymous)