Palliative care and hospice

1. PALLIATIVE CARE
AND HOSPICE
MEDICINE
BY- PRACHI RAGHAV 84-B

2. PALLIATIVE CARE
Palliative care, also known as
end-of-life care is defined by the
World Health Organization as
“multidisciplinary and holistic
assessment and management of
physical, psychosocial and
spiritual symptoms, with the
goal of alleviating suffering".

3. ALLPATIENTSREGARDLESSOFTHEIRDIAGNOSISSHOULDBEABLE
TOACCESSPALLIATIVECAREAPPROPRIATETOTHEIRCURRENT
INDIVIDUALNEEDS,TOALLOWTHISTOHAPPENANINTEGRATED
APPROACHTOPALLIATIVECAREISREQUIRED.THERISEINTHE
NUMBEROFELDERLYPEOPLE,ESPECIALLYTHOSEWHOHAVELITTLE
HOMESUPPORT,MAKESPALLIATIVECAREEVENMOREVITAL.PEOPLE
DYINGFROMSTROKE,DEMENTIA,ORMULTI-SYSTEMFAILURENEED
TOBEGUARANTEEDTHESAMELEVELOFCAREASTHOSETHATHAVE
ADIAGNOSISOFCANCER.

4. HOSPICE MEDICINE
Hospice care is a type of health care
that focuses on the palliation of a
terminally ill patient's pain and
symptoms and attending to their
emotional and spiritual needs at the
end of life. Hospice care prioritizes
comfort and quality of life by reducing
pain and suffering.

6. 0 to maximise the quality of life
to provide relief from pain and other
physical symptoms
to provide psychosocial and spiritual
care
to provide support to help the family
during the patient’s illness and in their
subsequent bereavement.
The goals of palliative care are:
TASKS OF
PALLIATIVE CARE

7. 0 Recognition and relief of pain and other
symptoms, whatever their causes
Recognition and relief of psychosocial
suffering, including appropriate care and
support for relatives and close friends.
Recognition and relief of
spiritual/existential suffering.
Sensitive communications between
professional care givers, patients,
relatives, and colleagues.
Respect for truth and honesty in all
dealings with patients, relatives, and
fellow professionals.
Inter-professional/multi-disciplinary team
caring where possible.
The key features of palliative care:
PALLIATIVE CARE
FEATURES

8. 0 Primary palliative care:- Delivered by
non palliative care specialists.
Specialty palliative care:-Delivered by
palliative care specialists
Home palliative care
Hospice
~ In the hospital
~ In the out patient clinic
~ At home
PLACES WHERE
PALLIATIVE CARE
IS GIVEN

9. REHAB TEAM
Oncologist
Physiatrist
Rehabilitation nurse
physical therapist
Occupational therapist
Lymph edema therapist
Recreational therapist
Dietitian
Cancer rehabilitation team may include the following:

10. 0 Traditional Rehab
Case Management
Skilled Maintenance
Supportive Care
Interventions
PALLIATIVE CARE
MODELS

11. TRADITIONALREHABMODELISUTILIZEDASPHYSICALTHERAPY
TREATMENTINSETTINGSOFACUTE,SUB-ACUTE,OUTPATIENT,AND
HOMEHEALTHREHAB.TREATMENTSARESCHEDULEDDAILYTOTWO
ORTHREETIMESAWEEKWITHTHEGOALOFIMPROVINGPATIENT
FUNCTIONANDLIMITINGIMPAIRMENTS.THISMODELISUTILIZED
EARLYINTREATINGPATIENTSWITHPALLIATIVECARENEEDSWHEN
REHABPOTENTIALISGOOD.

12. WHENAPATIENTHASACOMPLEXCONDITIONWITHMULTIPLE
COMORBIDITIES,ISHOME-BOUND,ANDDOESNOTHAVEANYMEDICAL
NEEDSORIMPAIRMENTSTHATAREOUTOFTHEABILITYFORTHEFAMILYOR
CAREGIVERTOSAFELYPROVIDEFORTHEPATIENT,ACASEMANAGEMENT
MODELWOULDFITWELLTOMONITORTHEPATIENTANDSAVECOSTS.
INTERMITTENTTREATMENTSESSIONSAPPOINTEDMONTHLY,BIMONTHLY,
OR“ASNEEDED”ARESET-UPTOREASSESSTHEFUNCTIONALSTATUSOF
THEPATIENT,CONTINUINGTOEDUCATETHECAREGIVERONPROPER
TRANSFERSANDEXERCISEFORM,ANDUPDATINGANYTHERAPEUTIC
EXERCISEPRESCRIBED.

13. SKILLEDMAINTENANCEMODELISSIMILARTOTHECASE
MANAGEMENTMODELINWHICHITOCCURSWHENPATIENTSHAVE
MEDICALCONDITIONSTHATWILLMAKEVERYLITTLEIFNOPROGRESS
INHEALTHPROGRESSION. SITUATIONSWITHISSUESSUCHAS
BALANCE,TONE,COORDINATIONORMEDICALCONDITIONSSUCHAS
CARDIOPULMONARYANDORTHOPAEDICCONDITIONSWOULD
REQUIRETHESERVICESANDEXPERTISEOFAPHYSICALTHERAPIST
OROTHERHEALTHCAREPROFESSIONAL.

14. INSUPPORTIVECARE,STEPSARETAKENTOENHANCEPATIENTCOMFORT
ANDIMPROVEQUALITYOFLIFEANDAREESSENTIALTOEFFECTIVEEND-OF-
LIFECARE,SUCHAS:MASSAGE(PROVIDESTEMPORARYRELIEF,LONGTERM
MANAGEMENTOFEDEMA,ANDREDUCESMUSCLETENSION),ACTIVE,
ASSISTIVE,ORPASSIVERANGEOFMOTION,GUIDEDIMAGERY(PROVIDESA
COMMONPLEASANTEXPERIENCEWHENCOMBINEDWITHRANGEOFMOTION
ACTIVITIES),VESTIBULARSTIMULATION(AGENTLEROCKINGMOTIONAND
PROVIDECOMFORT),CONVERSATION(PROVIDESSHARINGOF
INFORMATION,MEANING,ANDUNDERSTANDINGWHICHCANSUPPORTTHE
END-OF-LIFEPROCESS).

15. PHYSICALTHERAPYINPALLIATIVECAREISOFTENDIRECTED
TOWARDCONTROLLINGSYMPTOMSANDCOMPENSATINGFORLOST
FUNCTION.ININTERVENTIONMODEL,PHYSICALTHERAPISTSSHOULD
SEEKTOMAINTAINSTRENGTH,MAKEENVIRONMENTAL
MODIFICATIONS,FURNISHNECESSARYASSISTIVEEQUIPMENT,
TEACHENERGYMANAGEMENTTECHNIQUES,PROVIDEFAMILY
EDUCATION;ACHIEVESAFETY,INDEPENDENCE,MEANING,AND
QUALITYOFLIFE,DESPITETHEPHYSICALANDMENTALDECLINE
WHICHISEXPECTED.

16. 0 Reduced pain and other distress.
Improve health related quality of life
High patient and family satisfaction with
care. Increase likelihood of location of
death being out side of hospital.
Less depression.
Less aggressive care at the end of life.
Improvement in prevalence of moderate
to sever symptoms.
BENEFITS OF
PALLIATIVE CARE

17. THOUGHTHEPRINCIPLESOFPALLIATIVECAREAREAPPLICABLEIN
EACHOFTHEFOLLOWINGFIELDS,THEYARENOTTHESAMEAS
PALLIATIVECARESERVICES:
CAREOFTHEELDERLY(GERIATRICS),GENERALPRACTICE(FAMILY
MEDICINE),CAREOFTHECHRONICALLYILL,CAREOFCANCER
(ONCOLOGY),CAREOFTHEINCURABLE,PAINCLINIC/PAINRELIEF
SERVICE.
MOSTEMPHATICALLYPALLIATIVECAREISNOTEUTHANASIAOR
PHYSICIAN-ASSISTEDSUICIDE(PAS).

18. THANK YOU