Palliative care aims to improve quality of life for patients with serious illnesses through pain and symptom management as well as addressing physical, psychological, social, and spiritual needs. It focuses on preventing and relieving suffering for the patient and their family from diagnosis through the end of life and into bereavement. Palliative care is provided through interdisciplinary teams in various settings including hospitals, outpatient clinics, nursing homes, and in the community.

1. Palliative care
Dr. S. Parasuraman,
Faculty of Pharmacy,
AIMST University.

2. Palliative care
• Palliative care is a term derived from Latin palliare, "to cloak.“
• Palliative care is a multidisciplinary approach and specialized
medical care for people with serious illness.
• The goal of therapy is to improve the quality of the life.
• It’s focused on providing patients with relief from the symptoms,
pain, physical stress, and mental stress of a serious illness.
• A World Health Organisation statement describes palliative care
as "an approach that improves the quality of life of patients and
their families facing the problems associated with life-
threatening illness, through the prevention and relief of suffering
by means of early identification and impeccable assessment and
treatment of pain and other problems, physical, psychosocial and
spiritual."
"WHO Definition of Palliative Care". World Health Organization. Retrieved March 16, 2012.

3. Palliative care
• Palliative care teams specialize in treating people suffering
from the symptoms and stress of serious illnesses such as
cancer, congestive heart failure (CHF), chronic obstructive
pulmonary disease (COPD), kidney disease, Alzheimer’s,
Parkinson’s, Amyotrophic Lateral Sclerosis (ALS) and other
chronic disorders.

4. Issues addressed in palliative care
• Palliative care can address a broad range of issues,
integrating an individual’s specific needs into care. The
physical and emotional effects of cancer and its treatment
may be very different from person to person.
– Physical
– Emotional and coping
– Practical
– Spiritual

5. Issues addressed in palliative care
• Physical:
– Physical symptoms such as pain, fatigue, loss of appetite, nausea,
vomiting, shortness of breath, and insomnia can be relieved with
medicines or by using other methods, such as nutrition therapy,
physical therapy, or deep breathing techniques.
• Emotional and coping:
– Depression, anxiety, and fear that can be addressed through
palliative care. Experts may provide counseling, recommend
support groups, hold family meetings, or make referrals to mental
health professionals.

6. Issues addressed in palliative care
• Practical:
– Patients may have financial and legal worries, insurance questions,
employment concerns, and concerns about completing advance
directives. For many patients and families, the technical language
and specific details of laws and forms are hard to understand.
• Spiritual:
– An expert in palliative care can help people explore their beliefs and
values so that they can find a sense of peace or reach a point of
acceptance that is appropriate for their situation.

7. Key Components of Palliative Care
• Recognising symptoms such as pain, nausea, fatigue,
breathing or swallowing difficulties, constipation, and
hopelessness.
• Identifying the patient's goals and development of a
palliative care plan, specially for the patient.
• Understanding that many patients and their families
struggle to make decisions.
• Assisting with advanced care directives to help people
formulate and communicate their preferences regarding
care during future incapacity.

8. Models of Palliative Care
• Hospice Care – a well-established program to provide patients with a
prognosis of six months or less. As delineated within the Medicare Hospice
Benefit, these services can be provided in the home, nursing home,
residential facility, or on an inpatient unit.
• Palliative Care Programs – institutional based programs in the hospital or
nursing home to serve patients with life-threatening or life-limiting illnesses.
Occur in hospital settings (academic, community, rehabilitation) and skilled
nursing facilities. Provide services to patients anywhere along the disease
continuum between initial diagnosis and death.
• Outpatient Palliative Care Programs – occur in ambulatory care settings to
provide continuity of care for patients with serious or life-threatening
illnesses.
• Community Palliative Care Programs – occur in communities as consultative
teams who collaborate with hospices or home health agencies to support
seriously ill patients who have not yet accessed hospice.

9. Models of Palliative Care
• Hospice Care – a well-established program to provide patients with a
prognosis of six months or less. As delineated within the Medicare Hospice
Benefit, these services can be provided in the home, nursing home,
residential facility, or on an inpatient unit.
• Palliative Care Programs – institutional based programs in the hospital or
nursing home to serve patients with life-threatening or life-limiting illnesses.
Occur in hospital settings (academic, community, rehabilitation) and skilled
nursing facilities. Provide services to patients anywhere along the disease
continuum between initial diagnosis and death.
• Outpatient Palliative Care Programs – occur in ambulatory care settings to
provide continuity of care for patients with serious or life-threatening
illnesses.
• Community Palliative Care Programs – occur in communities as consultative
teams who collaborate with hospices or home health agencies to support
seriously ill patients who have not yet accessed hospice.
Read more: http://www.nationalconsensusproject.org/guideline.pdf

10. Domains of Quality Palliative Care
• Domain 1: Structure and Processes of Care
• Domain 2: Physical Aspects of Care
• Domain 3: Psychological and Psychiatric Aspects of Care
• Domain 4: Social Aspects of Care
• Domain 5: Spiritual, Religious and Existential Aspects of
Care
• Domain 6: Cultural Aspects of Care
• Domain 7: Care of the Imminently Dying Patient
• Domain 8: Ethical and Legal Aspects of Care
Read more: http://www.nationalconsensusproject.org/guideline.pdf

11. Domains of Quality Palliative Care
• Structure and Processes of Care -interdisciplinary team
assessment based on patient/family goals of care;
prognosis; disposition (level of care – inpatient unit, home);
safety
• Physical Aspects of Care – pain, dyspnea, nausea/vomiting,
fatigue, constipation, performance status, medical
diagnoses, medications (add/wean/titrate)
• Psychological Aspects of Care – anxiety, depression,
delirium, cognitive impairment; stress, anticipatory grief,
coping strategies; pharm/non-pharm treatment;
patient/family grief/bereavement;
• Social Aspects of Care – family/friend
communication/interaction/support; caregiver crisis

12. Domains of Quality Palliative Care
• Spiritual Aspects of Care – spiritual/religious/existential;
hopes/fears; forgiveness;
• Cultural Aspects of Care – language, ritual, dietary, other.
• Care of the Imminently Dying – presence; recognition and
communication to patient/family education/normalization;
prognosis (eg hours to days; very few days; etc)
• Ethical & Legal Aspects of Care – decision maker; advance
directives

13. Palliative Care - Malaysia
Read More: http://www.moh.gov.my/images/gallery/Polisi/PALLIATIVE_CARE.pdf

14. • Palliative medicine was introduced in the Ministry of Health
(MOH) in 1995.
• OBJECTIVES OF SERVICE
– To provide comfort and relief of distressing physical
symptoms related to advanced and incurable progressive life
threatening conditions.
– To provide support to patients and family members facing
psychosocial and spiritual issues related to incurable
progressive life threatening conditions.
– To prevent and minimize suffering by early identification,
impeccable assessment and prompt intervention of physical,
psychosocial and spiritual problems related to incurable
progressive life threatening conditions.

15. • OBJECTIVES OF SERVICE… Cont..,
– To promote understanding and respect towards patients at
the end of life and to prevent unnecessary and futile
interventions in order to allow a peaceful and dignified
death.
– To promote education in the field of palliative medicine and
palliative care for both healthcare and non-healthcare
professionals.
Read More: http://www.moh.gov.my/images/gallery/Polisi/PALLIATIVE_CARE.pdf

16. • SCOPE OF SERVICE
covers both cancer and non-cancer patients with progressive life
threatening illness including
– Medical management of chronic cancer pain and other
distressing physical symptoms related to advanced cancer.
– Medical management of pain and other distressing physical
symptoms related to progressive life-threatening non
cancerous illnesses.
• End stage cardiac disease
• End stage renal disease where dialysis support is not feasible
• Progressive neurodegenerative disorders
• Severe chronic airway limitation with deteriorating respiratory
function and poor candidate for ventilatory support
• Life threatening paediatric conditions
• HIV / AIDS not responding to anti-retroviral therapy
• Frailty in the elderly with multiple progressive comorbidities

17. • SCOPE OF SERVICE…. Cont..,
– Provision of psychosocial and spiritual supportive care to
patients and families facing life-threatening illness.
– Provision of terminal care for patients at the end of life.
– Provision of respite care for patients and families.
– Provision of consultative advice and assistance to other
medical colleagues regarding palliative management of
patients with life threatening situations under their care.
Read More: http://www.moh.gov.my/images/gallery/Polisi/PALLIATIVE_CARE.pdf

18. COMPONENTS OF SERVICE
• In-patient palliative care service.
• Out-patient palliative care service.
• Consultative palliative care service in general wards.
• Consultative palliative care service in other hospitals
without
• palliative care units.
• Community palliative care service.
• Day palliative care service.

19. PRINCIPLES OF PALLIATIVE CARE MANAGEMENT
• Scope of care: Includes patients of all ages with life-threatening
illness, conditions or injury requiring symptom relief from
physical, psychosocial and spiritual suffering.
• Timing of palliative care: Palliative care should ideally begin at
the time of diagnosis of a life threatening condition and should
continue through treatment until death and into the family’s
bereavement.
• Patient and family centred care: The patient and family
constitute the unit of care which should be managed as a whole.

20. PRINCIPLES OF PALLIATIVE CARE MANAGEMENT
• Holistic care: Palliative care must endeavour to alleviate suffering
in the physical, psychological, social and spiritual domains of the
patient in order to provide the best quality of life for the patient
and family.
• Multidisciplinary care: A multidisciplinary team approach is
essential to address all relevant areas of patient care.
• Effective communication: Good communication skills (including
listening, providing information, facilitating decision making and
coordinating care) are essential tools in palliative care and
healthcare providers must develop this in order to provide
effective palliative care.

21. PRINCIPLES OF PALLIATIVE CARE MANAGEMENT
• Knowledge and Skills: Palliative care is active care and
requires specific management for specific conditions.
• Seamless care: Palliative care is integral to all healthcare
settings (hospital, emergency department, health clinics and
homecare).

22. INTEGRATED MODEL OF PALLIATIVE CARE
Adapted from “Introducing Palliative Care” 4th Edition 2002 by Robert Twycross

23. Thank you