This document discusses hospice and palliative care. It begins by stating some key facts about death and the needs of dying patients. It then discusses why palliative care is needed to relieve suffering at the end of life. Palliative care aims to provide physical, psychological, social and spiritual support for patients and their families. The document outlines some obstacles to palliative care like lack of facilities and opioid restrictions. It compares the hospice approach, which focuses on whole-person care at the end of life, to a purely palliative one. The author believes hospice is superior for Iraq due to lower costs, cultural suitability, and relieving the burden of seeking a cure.

1. Hospice and Palliative Care
Dr. Hadi Awad Hmoud
MB.Ch.B, FICMS-S, MRCS-Ireland, LMCC-Canada

2.  Facts.
 Why we need Hospice or palliative
care.
 What palliative care means
 Obstacles for palliative care.
 Hospice Approach
 Which on is superior to other
Objectives

3. FACTS
 Death is inevitable, it is rather a normal
process.
 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
pieces.
 Care must be offered for dying patient and
caregiver too.

4. Rationale Questions
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
so?
4-Are these demands unreachable?

5. 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.

6. 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

8. Cure vs. Palliation
Cure:
Hope is eradication of disease.
Cure costs sacrifices.
Palliation:
Hope is comfort.
Any intervention that relieves
suffering is acceptable

9. How could we assess the patient’s
needs?
Physical.
Psychological.
Spiritual.
Social.

10. OLD MODEL OF CARE
CURATIVE
PROLONGATION
OF
LIFE
D
I
A
G
N
O
S
I
S
PALLIATIVE
RELIEF OF
SUFFERING
D
D
Predominantly curative
D
E
A
T
H

11. Curative Treatment
(Cancer, CHF, COPD, AIDS,
Dementia debilitating
Neurological diseases …)
Palliative Treatment
Bereavement Care
Hospice
DeathDiagnosis
Most Recent MODEL OF CARE
New aspects

12. Palliative care
 is specialized medical care for
people with end-stage illnesses. It
focuses on relieving suffering and
improving quality of life, regardless of
the diagnosis.
 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
support.

13.  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

14. Our accompleshment!!
Indeed we barely made it touchable
NOT Reachable

15. Obstacles for palliative care
Delay of the decision making .
Costs.
 Social and cultural issues.
Shortage of facilities.

16. Continue
Opiate especially Morphine restriction:
morphine is not readily available across
the country. It is recommended to be
given frequently and extended to a long
period.

17. Continue
Lack of trust between staff and
family.
Patient and family education
including other caregivers.
Education and training of palliative
care for medical staff, particularly
physicians and nurses is not
available.

20. Year NO of new cases register Male NO % Female NO % Registered cases per 100,000 Population
1991 5720 3125 54.63 2595 45.37 31.05
1992 8526 4735 55.54 3791 44.46 44.99
1993 8471 4632 54.68 3839 45.32 43.49
1994 7785 4230 54.34 3555 45.66 38.91
1995 7947 4344 54.66 3604 45.34 44.69
1996 8360 4466 53.42 3894 46.58 45.69
1997 8592 4521 52.62 4071 47.38 45.67
1998 9033 4774 52.85 4259 47.15 45.74
1999 8936 4556 50.98 4380 49.02 43.95
2000 10,888 5376 49.38 5512 50.63 52.00
001 13,332 6758 50.69 5674 49.31 61.38
002 13,985 6964 49.80 7021 50.20 62.97
003 11,248 5698 50.66 5550 49.34 49.17
004 14,520 7525 51.83 6995 48.17 61.63
005 15,172 7505 49.47 7667 50.53 54.26
006 15,226 7377 48.45 7849 51.54 52.84
007 14,213 6656 46.83 7557 53.16 47.88
008 14,180 6589 46.47 7591 53.53 44.46
Total 196,135 99,831 50.90 96,304 49.10 -
Rate of malignancies and Gender distribution in Iraq

21. Blue: Surveyed, Red: Officially registered
Rate and type of malignancies in Basra in 2008

22. Good Palliation Indicator
Morphine consumption can be used as an
approximate measure of pain control and
hence success of this form of palliative
care.
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

23. 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

24. Hospice
 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.

25.  It is a support to patients and
family members throughout the dying
Process.
 It offers bereavement follow up for
primary caregivers and family
members.
 It is an appropriate opportunity for
patients to meet those who shared
them the sufferings
 It is done in purposeful founded
Place(ACCOMODATION).

27. 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
for cure.
4-Cost-effective for the budget and resources.

30. Elderly Palliative care, the right to quality of lifeElderly Palliative care, the right to quality of life

31. Fear of way Of Death

32. God May Bless You All
Thank You