This document discusses palliative care and end-of-life care. It addresses how palliative care aims to improve quality of life for patients facing life-threatening illnesses through pain management and treatment of physical, psychosocial and spiritual problems. The document also discusses communicating with patients about end-of-life wishes, providing psychological and bereavement support for families, and ensuring patients have a peaceful death. The goal of palliative care is to never stop caring for patients, even when a cure is not possible.

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CONTENTS AND
understanding OF the
PRESENTATION :
An approach to the terminally ill – a learners point of view.
Understanding basics of palliative care.
How does it influences the life of a patient and his care
givers.
Domains and concerns of palliative care
How does or how should this learning influence you.

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PRESENTATION
A BASIC UNDERSTANDING
OF TERMINAL STAGE,
DEATH AND BEREAVMENT
CONSIDERING BOTH THE
PATIENT AND FAMILY
MEMBERS
UNDERSTANDING BASIC
PALLIATIVE CARE

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This is how we look at life.
We expect it
to just go on and on.

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But…
what if there is a chronic disease?

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Fortunately, medicine today can
help us recover and
keep us comfortable.

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However, at times
medicine cannot stop
the progress
of the disease.

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When the doctor indicates
the end is near,
the patient finds it
difficult to believe …
What! Am
I serious?
What
will
happen
to my
family?
How
long do
I have?

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Are you
sure?
… so does the family.
What
do we
do?
There is
nothing
you
can do?

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The patient and the
family must feel free to
share their fears and
concerns
with the doctor.
Is it
rude to
ask the
doctor?
Will the
doctor
have time
to talk to
us?
What if
my
question
is silly?
The doctor
knows best,
so why ask?

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This is the time for some honest communication, the
time to take some decisions together.

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No pain, no distress to
the patient at any time.
Always respect the
patient’s dignity, likes and
the right to make
decisions.
Allow the patient to
express preferences about
end-of-life care.

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I want to
die at
home. I want
my wife
near me
when I
die.
Tell my
friend to
forgive
me.
I want
the priest
to help
me pray.
No life
support
for me
please
It is important to
honour the patient’s
wishes.

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Apart from pain & comfort care, end-
of-life care provides:
 psychological,
 spiritual and
 social support.

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Life eventually
ends, but end-of-
life care does not.

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Bereavement
support helps the
family cope and
start afresh.

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End-of-life care is about never stopping to care,
even when we cannot cure.
“Never say ‘I can not do any thing more’,
Always say ‘I can do some thing more’”
Because there is always something more that we
can do.
“Never say No”

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The care with which we treat the dying affirms that
our humanity is living.

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Together we choose.

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Palliative Care is an approach that improves the quality of life of
patients and their families facing the problems associated with
life-threatening illnesses, through the prevention and relief of
suffering by means of
• early identification,
• impeccable assessment and
• treatment of pain and other problems, physical, psychosocial
and spiritual.
Definition:
REF: WORLD HEALTH ORGANISATION / PALLIATIVE CARE

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The Palliative Care approach aims to promote physical,
psychosocial and spiritual well-being.

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Good quality palliative care can be defined as the care,
which I would be happy to have given to a member of my
own family if he or she was dying, or to receive myself
when my time comes.

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History of palliative care
 Palliative care is not new.
 Care of the dying has been a constant
feature of human society throughout the
history.
 We have ancient traditions in India of
looking after those who are dying with
special care and attention.
 The Eighteen institutions built in India by
King Asoka (273 – 232 BC) had
characteristics very similar to modern
hospices. He had even established a refuge
for the dying in Varanasi near the sacred
river Ganges.
[REF: HANDBOOK FOR CERTIFICATE COURSE IN ESSENTIALS OF PALLIATIVE CARE;REVISED FOURTH EDITION 2015]

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 Best known for her role in the birth of the
hospice movement, emphasizing the
importance of palliative care in modern
medicine.
 She was a prominent Anglican, nurse,
physician and writer, involved with many
international universities.
 She helped the dying and terminally ill end
their lives in the most comfortable ways
possible .
 She developed the first ever hospice “St
Christopher’s Hospice” in 1948
Dame Cicely Mary Saunders
[REF: HANDBOOK FOR CERTIFICATE COURSE IN ESSENTIALS OF PALLIATIVE CARE;REVISED FOURTH EDITION 2015]

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Empathetic
Hospice care
Death autonomy
Clear decisions
Breaking bad news
Poly pharmacy
Holistic approach
Total pain
PALLIATIVE CARE:
A MULTI DISCIPLINARY & MULTI FOCUSED APPROACH

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Understanding pain: touch – healing – active
listening – mind shift –presence of near & dear
ones.
Avoiding unnecessary interventions
Respecting ones will
Not letting the sufferer feel underprivileged
Treating and caring more through the heart than
through the mind (brain)

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 With a crude death rate of 6.24/1000 and a population of more
than a billion, the total number of people dying every year in
India is about seven million.
 More than 4 million of them would benefit from palliative care.
 But only Less than 1% of those who need palliative care services
have any access to such services in the country.
 Kerala is the only state in India to have medical and legislative
norms to provide palliative care to the needy.
PROBLEM SCENARIO

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 The present medical establishment, with its hospital-
centred services, is geared basically to look after patients
with acute illness.
 This acute-care orientation is reflected in the current
emphasis on illness diagnosis, patient-initiated
consultations, and curative and/or symptom relieving
treatments.
 Patients with chronic and incurable illness on the other
hand need a regular system of support available in the
community.

34. How should this presentation help you ???

35. * You should have a more empathetic attitude
towards the sufferer.
* We must understand that caring doesn't end with the death of the
patient.
* Care should be by involving family and other health associates.
* Pain is not just physical, its more of the mind.
* A fundamental understanding of WHO pain ladder.
* Judicious use of analgesics.
* Palliative care is / can be given along with other on going
therapies.
* And PLAN YOUR DEATH–DEATH AUTONOMY/DEATH WILL.

36. KEY POINTS TO REMEMBER:
Palliative care is not necessarily for the terminally ill
It is not only for cancer patients
Morphine is the best analgesic to be given for refractory pain
management cases / for severe unbearable pain
Oral morphine is effective than I.V
(Morphine doesn't causes addiction, respiratory distress or any
major adverse effects)
Palliative medicine is a community approach.
Palliative care affirms dignity at end of life and ensures
bereavement care.

37. A good death is achieved when:
• The patient’s pain and other physical symptoms have been
adequately controlled
• The patient has had time to
- Evaluate his Life Journey
- Review his achievements and failures
- Forgive and ask for forgiveness
- Reconcile with self, family and God
- Say ‘I love you’
- Accept death and be ready to say ‘Good Bye’
Ultimately, the goal is to do what is good for the
patient and as life is drawing to a close, to lead him
towards a ‘good’ or peaceful death.

38. Plan your life so that you can live fully.
Plan your death so that you can die
peacefully.
“ LOVE YOUR LIFE - TO - DEATH “