This document discusses several myths and facts related to palliative care and opioids. It begins by addressing a common myth that having palliative care means a patient will die soon, and explains that palliative care is a holistic approach that can be provided alongside curative treatment. It then goes on to address additional myths around who can benefit from palliative care, how pain is managed, and where services are provided. The document aims to dispel misconceptions and ensure all patients have access to equitable and comprehensive end-of-life care.
Palliative care white paper for RegenceErin Codazzi
Writing this white paper for Regence was a humbling experience, connecting directly with the doctors, nurses, nonprofits and industry influencers dedicated to elevating the awareness for palliative care. It's an important topic and one every one of us should start talking about, as daunting as it may be. Grateful to the team at Regence for letting me dig deep on this one. Read the press release: http://news.regence.com/releases/regence-blueshield-releases-findings-on-the-importance-of-a-holistic-approach-to-palliative-care
SHARE Presentation: Palliative Care for Womenbkling
Dr. Michael Pearl discusses supportive palliative care for women with cancer, how it differs from hospice care, and the New York Palliative Care Information Act. Dr. Michael Pearl is Professor and Director of the Division of Gynecologic Oncology in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University Hospital.
From surviving to thriving: cancer’s next challengePwC Russia
Рак-диагноз, который никто не хочет услышать. Приуроченный к Всемирному дню борьбы с раком отчет PwC рассказывает об историях тех, кто пережил этот страшный период жизни и не сдался.
Palliative care white paper for RegenceErin Codazzi
Writing this white paper for Regence was a humbling experience, connecting directly with the doctors, nurses, nonprofits and industry influencers dedicated to elevating the awareness for palliative care. It's an important topic and one every one of us should start talking about, as daunting as it may be. Grateful to the team at Regence for letting me dig deep on this one. Read the press release: http://news.regence.com/releases/regence-blueshield-releases-findings-on-the-importance-of-a-holistic-approach-to-palliative-care
SHARE Presentation: Palliative Care for Womenbkling
Dr. Michael Pearl discusses supportive palliative care for women with cancer, how it differs from hospice care, and the New York Palliative Care Information Act. Dr. Michael Pearl is Professor and Director of the Division of Gynecologic Oncology in the Department of Obstetrics, Gynecology and Reproductive Medicine at Stony Brook University Hospital.
From surviving to thriving: cancer’s next challengePwC Russia
Рак-диагноз, который никто не хочет услышать. Приуроченный к Всемирному дню борьбы с раком отчет PwC рассказывает об историях тех, кто пережил этот страшный период жизни и не сдался.
Explores palliative and end of life care. Outlines advance care planning and provides information about planning ahead to include using advance healthcare directives
Robert A.S. Suntay
Robert Abad Santos Suntay is the co-founder and managing director of Carewell – the Cancer Resource and Wellness Community Foundation, Inc. Carewell is a volunteer-driven, non-stock, non-profit organization that provides support, education, and most important: hope – to persons with cancer and their loved ones.
Carewell provides psycho-social support resources and programs that enable all persons affected by cancer to cope more successfully with the myriad demands of the illness. Carewell offers support groups and counseling, medical consults and referrals, wellness and fun activities, talks and seminars, and access to information and support from around the world thanks to The Cancer Support Community – a global network of cancer support organizations of which Carewell is a member.
Prior to his involvement at Carewell, Bobbit Suntay was a longtime educator. He was formerly the high school principal of Xavier School, and an assistant professor of education and managing director of the Ateneo de Manila University Center for Educational Development. He is currently a board member of The Beacon School, The Beacon Academy, and The Principals’ Center at Harvard University.
HEALTHCARE PROFESSIONALS NEED TO USE THERAPEUTIC LIES FOR PROVIDING MENTAL AND PSYCHOLOGICAL SUPPORT TO THE ELDERLY SERVICE USERS. By OnlineAssignmentsHelp.com
Bridging Clinical Gaps and Disparities in Care in TNBCbkling
This webinar will focuses on racial, ethnic, and socioeconomic disparities with the clinical gaps in treatment for women with triple-negative breast cancer (TNBC). Our guest speaker Shonta Chambers, MSW, is the EVP of Health Equity and Community Engagement at the Patient Advocate Foundation and Principal Investigator for SelfMade Health Network. Come and learn about this complex subtype, barriers to care, address the myths and fears around clinical trials in specific racial and ethnic communities, and help bridge the clinical gaps to improve survival outcomes for patients with TNBC.
Althe DiscussionMy proposed service for Bellevue Hospital Ment.docxrobert345678
Althe Discussion:
My proposed service for Bellevue Hospital “Mental health program that focuses on LGBTQIA+ Youth” (NYC Health + Hospitals, 2022,). This program would include counseling that will help them manage stress and depression, suicide prevention, substance abuse, homelessness and other services (Trevor Project, n.d). LGBTQIA+ youth may encounter some “negative health and life outcomes”, so it is crucial for them to have access to these and as many other services as possible (Centers for Disease Control and Prevention, 2020). The negative health and life outcomes LGBTQIA+ Youth experiences are issues with coming out to their friends and or family, social or fear rejection, they may experience violence, some form of trauma as well as inadequate mental or medical care (D’Amore Mental Health, n.d). By offering these services Bellevue Hospital can help with making a difference in the health and social disparities LGBTQIA+ youths face.
My focus on two of the five Ps of health care marketing.
For this program I will use two of the five P’s of healthcare marketing “physicians and patients” (Cellucci et al., 2014). The ones that will be utilizing these services are the patients. This program will focus on supporting the needs of these patients and assures them that they have all the support services available to them. The two of the Five Ps that I can apply my proposal is public and patients. The public health of the LGBTQIA+ Youth population would be affected the most from this proposed service. Such as homelessness, substance abuse and suicide can affect the community. Public health, “aims to improve the health and well-being of a group or a population”, not person (Cellucci et al., 2014).
References:
Cellucci, L. W., Wiggins, C., & Farnsworth, T. J. (2014).
Healthcare marketing: A case study approach. VitalSource Bookshelf version. vbk://9781567936056
Centers for Disease Control and Prevention, (2020, December).
LGBT youth resources.
https://www.cdc.gov/lgbthealth/youth-resources.htm
D’Amore Mental Health. (n.d).
Mental health issues in LGBTQ youth.https://damorementalhealth.com/mental-health-issues-in-lgbtq-youth/
Trevor Project, (n.d).
Mental health: You matter. Let’s keep you thriving. https://www.thetrevorproject.org/resources/page/2/?s=Mental%20Health
NYC Health + Hospitals, (2022, Octobe
r). Community health needs assessment 2022.https://hhinternet.blob.core.windows.net/uploads/2022/10/2022-CHNA-ISP-Report.pdf
Reply to Thread
Sharon Discussion
The proposed service chosen for Bellevue Hospital NYC’s Behavioral Health Department is transcranial magnetic stimulation (TMS). TMS is a treatment for depression for patients who do not respond to other medication and therapies. TMS is a “noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” (Mayo Clinic, 2018) The treatment inv.
A lecture given at a Primary Care Conference in Massachusetts - on the important role primary care physicians could play in ensuring good palliative care for patients, communication, hospice, myths & realities
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Cancer Patients Awareness of Extent of Disease-Association with Psychological...Dr. Liza Manalo, MSc.
What is already known on this topic
►► In Southeast Asian cultures, the fear that should patients know their poor prognosis, they might become depressed, worry excessively, or lose the will to live has traditionally led families to request physicians for non-disclosure of diagnosis and prognosis.
►► The Asian Patient Perspectives Regarding Oncology Awareness, Care and Health (APPROACH) studies in other Asian countries revealed that patients who were aware or unsure of their prognosis reported higher levels of anxiety and depressive symptoms.
What this study adds
►► One of the most important findings in this study was the absence of an association between advanced cancer patients’ awareness of the extent of the disease and psychological morbidity.
►►Contrary to what might be expected, awareness of advanced cancer was associated with higher social well-being.
How this study might affect research, practice, or policy
►► The results of this research could impact how doctors in this cultural context communicate with cancer patients and allay concerns among families that sharing a cancer diagnosis and prognosis with the patient could lead to distress or worry. Future studies could focus on examining the effect of cultural beliefs and values, such as faith and spirituality, and social support networks on the well-being of cancer patients.
Discusses human life & human dignity, beginning of life issues like abortion and In Vitro Fertilization, as well as end of life issues like euthanasia, physician assisted suicide and
allowing natural death
Care of persons in the critical and terminal phases of life. With quotes from Samaritanus bonus, letter of the Congregation of the Doctrine of the Faith
Climate change protection of the environment-biosphere-biodiversity-laudato siDr. Liza Manalo, MSc.
Bioethics 1- Protection of the environment, biosphere and biodiversity in relation to the Sustainable Development Goals, climate change, conflict, health, and education.
The anthropological, philosophical and Christian teaching on human sexuality, marriage and the family. The Injustices of the Surrogacy Industry based on Catholic teaching on surrogacy is receiving reinforcement from current research.
End of life issues in advanced heart failure manalo palliative careDr. Liza Manalo, MSc.
Why aren’t countries accountable to commitment on end of life (#EOL) care for vulnerable people?
For lack of know-how. This presentation aims to teach cardiologists how to provide good palliative care to their patietnts.
Explores palliative and end of life care. Outlines advance care planning and provides information about planning ahead to include using advance healthcare directives
Robert A.S. Suntay
Robert Abad Santos Suntay is the co-founder and managing director of Carewell – the Cancer Resource and Wellness Community Foundation, Inc. Carewell is a volunteer-driven, non-stock, non-profit organization that provides support, education, and most important: hope – to persons with cancer and their loved ones.
Carewell provides psycho-social support resources and programs that enable all persons affected by cancer to cope more successfully with the myriad demands of the illness. Carewell offers support groups and counseling, medical consults and referrals, wellness and fun activities, talks and seminars, and access to information and support from around the world thanks to The Cancer Support Community – a global network of cancer support organizations of which Carewell is a member.
Prior to his involvement at Carewell, Bobbit Suntay was a longtime educator. He was formerly the high school principal of Xavier School, and an assistant professor of education and managing director of the Ateneo de Manila University Center for Educational Development. He is currently a board member of The Beacon School, The Beacon Academy, and The Principals’ Center at Harvard University.
HEALTHCARE PROFESSIONALS NEED TO USE THERAPEUTIC LIES FOR PROVIDING MENTAL AND PSYCHOLOGICAL SUPPORT TO THE ELDERLY SERVICE USERS. By OnlineAssignmentsHelp.com
Bridging Clinical Gaps and Disparities in Care in TNBCbkling
This webinar will focuses on racial, ethnic, and socioeconomic disparities with the clinical gaps in treatment for women with triple-negative breast cancer (TNBC). Our guest speaker Shonta Chambers, MSW, is the EVP of Health Equity and Community Engagement at the Patient Advocate Foundation and Principal Investigator for SelfMade Health Network. Come and learn about this complex subtype, barriers to care, address the myths and fears around clinical trials in specific racial and ethnic communities, and help bridge the clinical gaps to improve survival outcomes for patients with TNBC.
Althe DiscussionMy proposed service for Bellevue Hospital Ment.docxrobert345678
Althe Discussion:
My proposed service for Bellevue Hospital “Mental health program that focuses on LGBTQIA+ Youth” (NYC Health + Hospitals, 2022,). This program would include counseling that will help them manage stress and depression, suicide prevention, substance abuse, homelessness and other services (Trevor Project, n.d). LGBTQIA+ youth may encounter some “negative health and life outcomes”, so it is crucial for them to have access to these and as many other services as possible (Centers for Disease Control and Prevention, 2020). The negative health and life outcomes LGBTQIA+ Youth experiences are issues with coming out to their friends and or family, social or fear rejection, they may experience violence, some form of trauma as well as inadequate mental or medical care (D’Amore Mental Health, n.d). By offering these services Bellevue Hospital can help with making a difference in the health and social disparities LGBTQIA+ youths face.
My focus on two of the five Ps of health care marketing.
For this program I will use two of the five P’s of healthcare marketing “physicians and patients” (Cellucci et al., 2014). The ones that will be utilizing these services are the patients. This program will focus on supporting the needs of these patients and assures them that they have all the support services available to them. The two of the Five Ps that I can apply my proposal is public and patients. The public health of the LGBTQIA+ Youth population would be affected the most from this proposed service. Such as homelessness, substance abuse and suicide can affect the community. Public health, “aims to improve the health and well-being of a group or a population”, not person (Cellucci et al., 2014).
References:
Cellucci, L. W., Wiggins, C., & Farnsworth, T. J. (2014).
Healthcare marketing: A case study approach. VitalSource Bookshelf version. vbk://9781567936056
Centers for Disease Control and Prevention, (2020, December).
LGBT youth resources.
https://www.cdc.gov/lgbthealth/youth-resources.htm
D’Amore Mental Health. (n.d).
Mental health issues in LGBTQ youth.https://damorementalhealth.com/mental-health-issues-in-lgbtq-youth/
Trevor Project, (n.d).
Mental health: You matter. Let’s keep you thriving. https://www.thetrevorproject.org/resources/page/2/?s=Mental%20Health
NYC Health + Hospitals, (2022, Octobe
r). Community health needs assessment 2022.https://hhinternet.blob.core.windows.net/uploads/2022/10/2022-CHNA-ISP-Report.pdf
Reply to Thread
Sharon Discussion
The proposed service chosen for Bellevue Hospital NYC’s Behavioral Health Department is transcranial magnetic stimulation (TMS). TMS is a treatment for depression for patients who do not respond to other medication and therapies. TMS is a “noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” (Mayo Clinic, 2018) The treatment inv.
A lecture given at a Primary Care Conference in Massachusetts - on the important role primary care physicians could play in ensuring good palliative care for patients, communication, hospice, myths & realities
How useful are advance directives in directing end of life care and do people really understand or want to know the true status of their health as the end nears?
Cancer Patients Awareness of Extent of Disease-Association with Psychological...Dr. Liza Manalo, MSc.
What is already known on this topic
►► In Southeast Asian cultures, the fear that should patients know their poor prognosis, they might become depressed, worry excessively, or lose the will to live has traditionally led families to request physicians for non-disclosure of diagnosis and prognosis.
►► The Asian Patient Perspectives Regarding Oncology Awareness, Care and Health (APPROACH) studies in other Asian countries revealed that patients who were aware or unsure of their prognosis reported higher levels of anxiety and depressive symptoms.
What this study adds
►► One of the most important findings in this study was the absence of an association between advanced cancer patients’ awareness of the extent of the disease and psychological morbidity.
►►Contrary to what might be expected, awareness of advanced cancer was associated with higher social well-being.
How this study might affect research, practice, or policy
►► The results of this research could impact how doctors in this cultural context communicate with cancer patients and allay concerns among families that sharing a cancer diagnosis and prognosis with the patient could lead to distress or worry. Future studies could focus on examining the effect of cultural beliefs and values, such as faith and spirituality, and social support networks on the well-being of cancer patients.
Discusses human life & human dignity, beginning of life issues like abortion and In Vitro Fertilization, as well as end of life issues like euthanasia, physician assisted suicide and
allowing natural death
Care of persons in the critical and terminal phases of life. With quotes from Samaritanus bonus, letter of the Congregation of the Doctrine of the Faith
Climate change protection of the environment-biosphere-biodiversity-laudato siDr. Liza Manalo, MSc.
Bioethics 1- Protection of the environment, biosphere and biodiversity in relation to the Sustainable Development Goals, climate change, conflict, health, and education.
The anthropological, philosophical and Christian teaching on human sexuality, marriage and the family. The Injustices of the Surrogacy Industry based on Catholic teaching on surrogacy is receiving reinforcement from current research.
End of life issues in advanced heart failure manalo palliative careDr. Liza Manalo, MSc.
Why aren’t countries accountable to commitment on end of life (#EOL) care for vulnerable people?
For lack of know-how. This presentation aims to teach cardiologists how to provide good palliative care to their patietnts.
Considerations when deciding about withholding or withdrawing life-sustaining...Dr. Liza Manalo, MSc.
Towards the end of life, physicians face dilemmas of discontinuing life-sustaining treatments or interventions. In some circumstances, these treatments are no longer of benefit, while in others the patient or family no longer want them. The physician plays an essential role in clarifying the goals of medical treatment, defining the care plan, initiating discussions about life-sustaining therapy, educating patients and families, helping them deliberate, making recommendations, and implementing the treatment plan. Communication is key. It should be clarified that when inevitable death is imminent, it is legitimate to refuse or limit forms of treatment that would only secure a precarious and burdensome prolongation of life, for as long as basic humane, compassionate care is not interrupted. Agreement to DNR status does not preclude supportive measures that keep patients free from pain and suffering as possible. Acceptable clinical practice on withdrawing or withholding treatment is based on an understanding of the medical, ethical, cultural, and religious issues. There is a need to individualize care option discussions to illness status, and patient and family preferences, beliefs, values, and cultures. The process of shared decision making between the patient, the family, and the clinicians should continue as goals evolve and change over time.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Telehealth Psychology Building Trust with Clients.pptx
Busting Opioids Myths.ppsx
1. mcmanalo@themedicalcity.com
Busting Palliative Care &
Opioid Myths:
Ensuring Equity in Access
for Cancer Patients
Dr. Maria Fidelis Manalo, MSc.
Palliative Care
Augusto P. Sarmiento Cancer Institute
The Medical City
Philippines
4. mcmanalo@themedicalcity.com
MYTH:
Having palliative care
means you will die
soon.
FACT:
Palliative care is not just
for the end of life. It is a
holistic approach that
includes caregiver
support, spiritual care,
bereavement and much
more.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
5. mcmanalo@themedicalcity.com
MYTH:
Supportive and
palliative care is just
for people with
cancer.
FACT:
All those who are
diagnosed with a
chronic life-limiting
illness can benefit
from palliative care.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
6. mcmanalo@themedicalcity.com
MYTH:
Palliative care
manages pain
through the use of
addictive narcotics.
FACT:
Palliative care is holistic
care that provides
psychosocial and spiritual
care along with pain and
symptom management.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
7. mcmanalo@themedicalcity.com
MYTH:
I can only get
palliative care in a
hospital.
FACT:
Palliative care services
are offered in many
places, including
hospitals, hospices, and in
your own home.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
8. mcmanalo@themedicalcity.com
MYTH:
Palliative care is
generally just for old
people.
FACT:
Supportive and
palliative care is for
people of all ages.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
9. mcmanalo@themedicalcity.com
MYTH:
Choosing palliative
care means that I'm
"giving up."
FACT:
When a cure is no longer
possible, supportive and
palliative care provides the type
of care most people say they
want at the end of life--comfort
and quality of life. The most
common statement made by
families who chose palliative
care for their loved one is, "we
wish we had known about
palliative care sooner."
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
10. mcmanalo@themedicalcity.com
MYTH:
My grandmother died in a
great deal of pain, but
that's just to be expected
as part of the dying
process.
FACT:
Supportive and palliative care
doctors, oncology and pain
nurses, and others are
specially trained to control
each person's pain, while still
keeping the patient awake and
alert whenever possible.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
11. mcmanalo@themedicalcity.com
MYTH:
Everyone has access
to supportive and
palliative care.
FACT:
Though every person has the
right to supportive and
palliative care, there are many
around the world who does not
have access to supportive and
palliative care. In fact only
about 12% of the need for
palliative care is currently being
met worldwide.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
12. mcmanalo@themedicalcity.com
MYTH:
If I choose supportive
and palliative care, I'll
have to give up my
own doctor(s).
FACT:
This is never true. Patients in
palliative care remain under the
care of their own physician or
physicians, who work with the
patient, family, and the
palliative care team to enhance
quality of life and ensure that
the patient is as comfortable as
possible, day in and day out.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
13. mcmanalo@themedicalcity.com
MYTH:
I want to care for my
husband at home; I don't
want him to go to a
hospital or a hospice.
FACT:
Palliative care is not a place,
but a philosophy of care. The
majority of palliative care
takes place in the home,
where the person can be
surrounded by family and
familiar settings.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
14. mcmanalo@themedicalcity.com
MYTH:
Palliative care just
keeps terminally-ill
people heavily
medicated; all they
focus on is the physical
process of a dying.
FACT:
Palliative care is highly specialized
and tailored to each individual, to
ensure the highest quality of life
possible to live each day until the
end. In addition, palliative care
utilizes complementary therapies
such as music and art, and provides
emotional and spiritual support to
the terminally-ill person and the
loved ones, including grief therapy
and bereavement support for the
family afterwards.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
15. mcmanalo@themedicalcity.com
MYTH:
My son's doctor
suggested supportive
and palliative care; that
must mean that my son
has only a few days left
to live.
FACT:
Supportive and palliative
care is available to
anyone who has a life-
threatening or terminal
illness, regardless of
prognosis.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
16. mcmanalo@themedicalcity.com
MYTH:
My partner is dying of AIDS,
and I want the most
compassionate care possible
for him. But someone told me
palliative care is only for older
people with cancer.
FACT:
Palliative care programs
have developed
guidelines to care for
anyone, at any age,
facing a life-threatening
or terminal illness.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
17. mcmanalo@themedicalcity.com
MYTH:
My grandfather doesn't
have private insurance,
so he won't be able to
afford good end-of-life
care when he needs it.
FACT:
Palliative care physicians are
accredited by Philhealth. They
give senior citizen’s discount.
Since the focus of care has
shifted to comfort measures,
the palliative care physician
helps the family cut down
expenses arising from futile
diagnostics and therapeutics at
the end-of-life.
https://www.chpca.ca/wp-content/uploads/2020/03/2020myths-sheet-enfinal.pdf
mcmanalo@themedicalcity.com
18. mcmanalo@themedicalcity.com
Definition of
Palliative Care
Palliative care is an approach to
patient/family/caregiver-centered health
care that focuses on optimal management
of distressing symptoms, while
incorporating psychosocial and spiritual
care according to patient/family/caregiver
needs, values, beliefs, and cultures.
21. mcmanalo@themedicalcity.com
PAIN –
A feared and burdensome symptom
• Sources of pain:
– Due to cancer – local invasion
of tissues, obstruction
syndromes, metastases, etc
– Due to cancer treatment – post-
operative pain, phantom limb,
etc
– Pain related to cancer or
disability – bed sores, muscle
spasms, etc
– Pain due to other conditions –
arthritis, migraine, etc
• Up to 80% of advanced stage cancer patients suffer uncontrolled pain1
Types of Cancer Pain Prevalence
Head and Neck 67-91%
Prostate 56-94%
Uterine 30-90%
Genitourinary 58-90%
Breast 40-89%
Pancreatic 72-85%
Gastrointestinal 44-74%
Lung 44-67%
1. ACHEON Working Group, Kim YC, et al. Cancer Med 2015;4:1196-1204.
2. IASP - Epidemiology of Cancer Pain. Fact Sheet.
3. Scott-Warren J, Bhaskar A. Continuing Education in Anaesthesia Critical Care & Pain 2014;14(6):278–284
22. mcmanalo@themedicalcity.com
FACTS ABOUT CANCER PAIN
• 90 % of cancer pain can be satisfactorily controlled with current pain medications
• At least 25 % of cancer patients still die with unrelieved pain
1. Woodruff R, Palliative Medicine 4th ed., 2004
2. Bruera E., De Lima L., Wenk R., & Farr W., (eds), Palliative Care in the Developing World.,
3. International Association for Hospice and Palliative Care, 2004
4. Clearly J., J Palliative Medicine., 2007, 10 (6): 1369 – 1394.
23. mcmanalo@themedicalcity.com
Unrelieved Cancer Pain
Impairs Quality Of Life
• Loss of appetite
• Lack of sleep
• “Bad” mood
• Interference with relationships, Social isolation
• Depression, Anxiety
• Loss of energy and vitality
• Inability to perform daily activities
• Loss of income
• Challenge of existential beliefs
Watson M., Lucas C., Hoy A., & Wells J., Oxford Handbook of Palliative Care 2nd ed., 2009
25. mcmanalo@themedicalcity.com
A Validation Study Of The WHO Analgesic Ladder:
A Two-step Vs Three-step Strategy
Maltoni M. et al. Supportive Care Cancer, 2005 ; 13: 888-894.
Conventional Innovative
Approach Three-step strategy Two-step strategy
Pain Control
Transition from Step 1 to Step
2 does not improve analgesia,
and delays optimal pain
control
Patients receiving Step 3
(strong opioids) early had
significantly better pain relief
Satisfaction
Analgesia and patient
satisfaction with Step 1
analgesics alone and Step 2
analgesics is the same
Patients receiving Step 3 early
had greater satisfaction with
treatment
26. mcmanalo@themedicalcity.com
Current Recommendations
1. Marinageli F., Ciccozzi A., & Leonardis M., J Pain & Symptom Management, 2004 May; 27 (5): 409 – 416.
2. Maltoni M. et al, Supportive Care Cancer, 2005; 13: 888 – 894.
3. Mercadante S., Portio G, & Ferrera P., J Pain & Symptom Management, 2006 March; 31 (3): 242 - 247.
Moderate to severe cancer pain
Omit Step 2 of the WHO analgesic ladder and use Step 3
(strong opioids) for moderate to severe cancer pain
Strong opioids form the cornerstone in the
analgesic treatment of cancer pain
28. mcmanalo@themedicalcity.com F. Javier and M. Calimag, Opioid Use in the Philippines – 20 years after the introduction of the WHO analgesic ladder. Eur J Pain Supp 1 (2007) 19-22
30. mcmanalo@themedicalcity.com
Opioids and Dyspnea
• Opioids have been the most widely studied agent in the
treatment of dyspnea.
• Opioids treat dyspnea through many mechanisms:
o Reducing respiratory drive
o Reducing anxiety
o Altering central responses to exertion
o Cough suppression
- American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease.
Chest 2010;
- Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: a clinical practice guideline
from the American College of Physicians. Ann Intern Med 2008;
- Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea.
BMJ 2003.
mcmanalo@themedicalcity.com
31. mcmanalo@themedicalcity.com
Strong Opioids Available In The Philippines
Morphine Oxycodone Fentanyl Buprenorphine
Formulations
Oral (tablets)
Parenteral
Oral (tablets,
capsules, oral
solution)
Parenteral
Parenteral
Submucosal
Transdermal
Transdermal
Activity μ and κ μ and κ μ
μ partial agonist
κ antagonist
Bioavailability ≤40% 60-87%
SL - 54%
Transdermal – 92%
15%
Protein binding 30-35% 45% 80-85% 96%
Potency -
Twice as potent as
morphine
100x as potent as
morphine
75-115x as potent as
morphine
Use for opioid
naïve patients
Yes Yes Contraindicated* Yes
1. P&T Product Profiler Abstral®. February 2011
2. Riley J et al. Curr Med Res Opin 2008;24(1):175-192.
3. Levy MH et al. Eur J Pain 2001;5(Suppl. A):113-116.
4. Biancofiore G. Ther Clin Risk Manage 2006;2(3):229-234.
5. Curtis GB et al. Eur J Clin Pharmacol 1999;55(6):425-429.
6. Buprenorphine (TRANSTEC®) 35, 52.5 and 70 micrograms transdermal patch PH PI based on UK SmPC (v.16 Oct 2011). Revised 10 October 2017
33. mcmanalo@themedicalcity.com
O p i o i d M y t h 1
Myth: Opioids are addicting.
Fact:
• There is a difference between physical dependence
and addiction.
• Physical dependence is a state in which physical
withdrawal symptoms occur when a medication is
stopped or decreased abruptly. This is expected.
• Addiction is a chronic disease in which people have a
poor control over drug use and continue to use the
drug despite physical and social harm.
• Addiction is rare for patients who are terminally ill
when the goal of care is comfort.
https://getpalliativecare.org/morphine-myths-reality/
mcmanalo@themedicalcity.com
34. mcmanalo@themedicalcity.com
O p i o i d M y t h
2Myth: If a person takes large doses of
opioids early in their disease process,
the opioids will not be as effective later
on when he/she needs higher doses.
FACT: There is no ceiling or maximum
dose for opioids. A patient should get
whatever dose is needed to provide pain
relief. One should not focus on “the
numbers” but instead be focused on
making sure the patient’s pain is
controlled.
https://getpalliativecare.org/morphine-myths-reality/
35. mcmanalo@themedicalcity.com
O p i o i d M y t h 3
MYTH: “I’ve heard that Morphine has
lots of side effects, and I feel bad
enough already.”
FACT: All opioids can cause nausea,
drowsiness and constipation. However,
all side effects will generally stop after
a few days, as your body adjusts, and
constipation can be easily treated.
https://getpalliativecare.org/morphine-myths-reality/
36. mcmanalo@themedicalcity.com
O p i o i d M y t h 4
MYTH: “ My doctor recommended
Morphine, but that was what my
father took just before he died – is
the doctor not telling me
something?”
FACT: Opiates are excellent drugs for
treating moderate to severe pain. If
you have an illness that is causing
acute or chronic pain that is not
adequately reduced by paracetamol
or ibuprofen, talk to your doctor
about using opiates. Morphine (and
other opiates) is NOT just for people
who are dying.
https://getpalliativecare.org/morphine-myths-reality/
mcmanalo@themedicalcity.com
37. mcmanalo@themedicalcity.com
O p i o i d M y t h 5
MYTH: Morphine is dangerous, because
it can make breathing slow down to a
dangerously low rate.
FACT:
• Morphine and other opioids are not
dangerous respiratory depressants
when used appropriately, for people
experiencing pain.
• Doses are increased gradually, and
the body quickly adjusts.
• Pain is a great stimulant to breathe!
• Sedation and drowsiness always
precede opioid induced respiratory
depression.
http://hpcconnection.ca/some-common-misconceptions-about-opioids/
mcmanalo@themedicalcity.com
38. mcmanalo@themedicalcity.com
Myth: Opioids cause a
person to feel foggy and lose
control.
FACT: When opioids are
taken on a regular basis,
tolerance quickly develops
and the feeling of being
foggy or out of control
should go away within a
week.
O p i o i d M y t h 6
mcmanalo@themedicalcity.com
39. mcmanalo@themedicalcity.com
Myth: Opioids damage the body.
FACT: Opioids are very safe drugs
when used as directed. Of interest,
the American Geriatric Society has
determined that opioids are safer
for older people than non-
steroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen or
naproxen.
O p i o i d M y t h 7
40. mcmanalo@themedicalcity.com
Myth: Not all types of pain respond
well to opioids.
FACT: Pain caused by nerve injury
(neuropathic) respond well to opioids.
Pain caused by bone injury may need
the help of additional medications
along with opioids to provide better
relief for these types of pain.
O p i o i d M y t h 8
41. mcmanalo@themedicalcity.com
O p i o i d M y t h
9
Myth: Using opioids means that
you are a weak or bad person.
FACT: Because there have been
many stories in the news about
people who abused opioids,
their legitimate use for pain has
been questioned. As a result, too
many people suffer with pain
who could be relieved with
opioids.
mcmanalo@themedicalcity.com
42. mcmanalo@themedicalcity.com
O p i o i d M y t h 1 0
Myth: You cannot give
opioids to a child.
FACT: Children of all ages
can receive opioids at doses
appropriate for their weight
and age and with
adjustments based on
physical condition.
43. mcmanalo@themedicalcity.com
Each year, an estimated 40
million people are in need of
palliative care; 78% of them
people live in low- and middle-
income countries.
Adequate national
policies, program,
resources, and training on
palliative care among
health professionals are
urgently needed in order
to improve access.
The global need for palliative care
will continue to grow as a result of
the ageing of populations and the
rising burden of noncommunicable
diseases and some communicable
diseases.
Early delivery of palliative care
reduces unnecessary hospital
admissions and the use of health
services.
https://www.who.int/news-room/fact-sheets/detail/palliative-care
44. mcmanalo@themedicalcity.com
C a n y o u b e p a r t o f
t h e s o l u t i o n t o t h e
l a c k o f e q u i t y i n
a c c e s s t o
p a l l i a t i v e c a r e ?
IASP - Epidemiology of Cancer Pain. Fact Sheet. http://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/CancerPainFactSheets/Epidemiology_Final.pdf