The document provides an overview of palliative care, including: 1) It defines palliative care as the active total care of persons with advanced, progressive diseases, with a focus on controlling symptoms physically, psychologically, socially, and spiritually to improve quality of life. 2) It discusses the physical, psychological, social, and spiritual components of palliative care, highlighting how an interdisciplinary team assesses and manages symptoms using evidence-based guidelines while contextualizing treatment plans to patient's disease status and goals. 3) It emphasizes the importance of addressing psychological, social, and spiritual well-being through open communication, social support, spiritual assessments, and consideration of patients' and families' beliefs, relationships

1. BASIC COURSE IN
PALLIATIVE CARE
Mohamed Saber, Msc, CSBB

2. Agenda
■ Define palliative care.
■ Describe the palliative care trajectory for chronic diseases.
■ Discuss the physical, psychological, social, and spiritual components of palliative care

3. What do you know about Palliative
Care?

4. Our BestTeachers –The Patients

5. Death and Dying
Late 1800sDeath common
■ Families cared for dying patients
Early to mid 1900’sWorldWar I
■ Discovery of Penicillin
■ Emergence of infection control
■ Cure of communicable diseases

6. Question
■ If you had the
choice to choose
the place you want
to die in, where
would it be?

7. Where do people die?
■ Hospitals 59%
■ Residences 20%
■ Nursing Home 17%
■ Other 6%

8. SocietalView of Death and Dying
■ DEATH = FAILURE

9. Palliative Care
■ The active total care of persons with advanced, progressive diseases
•Focus: control of symptoms:
■ Physical
■ Psychological
■ Social
■ spiritual
■ Goal: improve QoL for patients and their families
■ It may be provided throughout course of disease in conjunction with disease-modifying
treatment

10. Palliative Care Is Palliative Care IsNOT
Excellent, evidence-based
medical treatment
Not “giving up” on a patient
Vigorous care of pain and
symptoms throughout illness
Not in place of curative or life-
prolonging care
Care that patients want at the
same time as efforts to cure or
prolong life, when appropriate
Not the same as hospice

11. Palliative Care model

12. Physical Aspects of Palliative Care

13. Symptoms Experienced by Patients at
the End of Life
■ Asthenia/Fatigue
■ Anorexia
■ Pain
■ Nausea
■ Dyspnea
■ Constipation
■ Sedation and Confusion
■ Xerostomia

14. The interdisciplinary team assesses
and manages symptoms using the
best available evidence:
■ Evidence based assessment tools & treatment guidelines are used
■ Ongoing assessments are documented
■ Interventions e.g. pharmacological, behavioral, and complementary
interventions
■ Barriers to use of opioids are assessed and addressed

15. The assessment and management of
symptoms and side effects are
contextualized to the disease status
■ Treatment plans are developed in context of disease, prognosis, and functional
limitations
■ Patient and family/surrogate understanding of illness is assessed in relation to patient-
centered goals
■ Patient/family understanding of illness and treatment options assessed with
consideration to culture, cognitive function, and developmental stage

16. Psychological Aspects of Palliative
Care

18. Psychological Care
■ Disease affects patients and their families
■ 35-70% of people with cancer suffer from anxiety and depression
■ Nurses spend the most time with patients and families
■ Communication is vital in this situation.

19. Improving Psychological Outcomes
■ Nurses often hear the concerns of patients and families
■ However, nurses often lack confidence in addressing psychosocial concerns
■ Nurses communication often improves quality of life and adjustment.
■ Nurses have flexible communication styles to meet patient needs.

20. Psychological Issues
■ Fears
■ Distress
■ Anxiety
■ Sadness and depression
■ Grief
■ Anger
■ Spiritual distress

21. Case Scenario
■ 42 yrs old man with colon cancer with liver and bone
mets.
■ On palliative chemotherapy
■ Side effects of chemo.
■ Chemo stopped & continued supportive management.
■ Pt. crying in front of the nurse to express his feelings.
■ If you were the nurse, what would you do next?

22. In the Actual Situation
■ The nurse asked if he would like to express his feelings.
■ He started with : “The problem is not the disease, the problem is I would like to see my
family together again before I die ” wife with psychological disorders on treatment at
mental health institution
■ 5 kids (3 boys + 2 girls)
■ MultidisciplinaryTeam: Social worker + Sheikh
■ psychosocial intervention

23. The outcome…
■ The family united again as a loving family

24. SocialWell-Being
■ Relationships (family, friends, work, other)
■ Role description
■ Caregiver burden
■ Impact on children
■ Symptom concerns
■ Financial concerns

25. Caregiver Defined
■ “A friend or relative who provides
unpaid assistance to a person
with a chronic or disabling
condition.”

26. Q: Caregiver burden affects?
A. Emotional health
B. Social well-being
C. Financial situation
D. Physical health
E. Spiritual well-being
■ F.All of the above (this is correct answer)

27. GENERAL PROCESSES OF CARE
National Consensus Project for Quality
Palliative Care
■ Enable patients to make informed decisions about their care by educating
them on the process of their disease, prognosis, and benefits and burdens of
potential interventions.
■ Provide education and support to families and unlicensed caregivers based on
the patient’s individualized care plan to assure safe and appropriate care for
the patient.

28. GENERAL PROCESSES OF CARE
National Consensus Project for Quality
Palliative Care
Conduct regular patient and family care conferences with physicians and
interdisciplinary team to provide information, discuss goals of care, disease
prognosis, and advanced care planning, and offer support.
Develop and implement a comprehensive social care plan which addresses the
social, practical, and legal needs of the patient and caregivers, including:
relationships, communication, existing social and cultural networks, decision-
making, work and school settings, finances, caregiver availability/stress, and access
to medicines/equipment.

29. Empathy: What is it toYou?
■ Using Empathy
■ An understanding so intimate
■ that the feelings, thoughts and
■ motives of one are readily comprehended by another
■ A way of knowing another
■ A way of being in the world
■ A stepping into one’s shoes for a brief moment
■ Imagining what another is going through

30. Spiritual Aspects of Palliative Care

31. What is Spirituality?
A personal search for meaning and purpose in life, which may or may not be related to religion
Tanyi, 2002
■ “Spirituality” is rarely used –difficult to understand Stories about life
■ Relationships with self and others
■ Relationships with music and nature
■ Relationship with God or a higher being
■ Hope, meaning, and purpose in life
■ Religion

32. What do the experts say?
International Association for Hospice and
Palliative Care
“ In the environment of Palliative Medicine and particularly in the end-of-life
stage, there is ever-increasing evidence that the control of physical and
emotional symptoms and the management of psychosocial problems
represent only a part of the management of a patient’s suffering. ”
Need to address Spirituality as well

33. FICA Spiritual Assessment
■ F:What is your faith or belief? Do you consider yourself spiritual or
religious?What things do you believe in that give meaning to your life?
■ I: Is it important in your life?What influence does it have on how you
take care of yourself? How have your beliefs influenced in your behavior
during this illness?What role do your beliefs play in regaining your
health?
■ C: Are you part of a spiritual or religious community? Is this of support to
you and how? Is there a person or group of people you really love or who
are really important to you?
■ A: How would you like me, your healthcare provider to address these
issues in your healthcare?

34. Take home message

35. What about you?
■ Palliative care within your institution
■ Barriers to palliative care delivery
■ Opportunities that exist within organization