Thomas Nyambo MD

Palliative Care
November 14, 2019
 Palliative care
Definition
• Palliative care is a specialized medical care for people with
serious illness.
• This type of care is focused on providing relief from the
symptoms and stress of a serious illness.
• The goal is to improve quality of life for both the patient
and the family.
• Quality of life (QOL) is a standard level that consists of the
expectations of an individual or society for a good life
which are guided by the values, goals and socio-cultural
context in which an individual lives.
• It focuses on standard level for emotional, physical,
material and social well-being.
 What is palliative care c.t.d
Medical care that focuses on alleviating
the intensity of symptoms of disease.

Palliative care focuses on reducing the

prominence and severity of symptoms.
 Hospice care
• Hospice care is a type of care and philosophy of
care that focuses on the palliation of a chronically
ill, terminally ill or seriously ill patient's pain and
symptoms, and attending to their emotional and
spiritual needs.
• Hospice can be provided in any setting—
home, nursing home, assisted living facility, or
inpatient hospital.
Difference Between Palliative Care and hospice care
• Both palliative care and hospice care provide
comfort.
• But palliative care can begin at diagnosis, and at
the same time as treatment.
• Hospice care begins after treatment of the
disease is stopped and when it is clear that the
person is not going to survive the illness
 Palliative and End-of-Life Care Differences
• End-of-life care is care occurring in the last part of a
patient’s life, typically in the last few months,
depending on the underlying diagnosis and clinical
course and also includes planning for end-of-life
care.
• Palliative care includes end-of-life care, but also
entails much more.
• Palliative care is care that focuses on improving the
quality of life and quality of care for patients with
life-threatening or life-limiting illness and their
families through the prevention and relief of
suffering.
 Palliative care team
 Usually provided by a team of individuals
 These are Interdisciplinary group of professionals
 Doctors
 Nurses
 social workers
 Pharmacists
 Nutritionists
 Religious people(Sheikhs,Priests)
 A Historical Perspective
• Palliative care began with a focus on the care of
the dying.
• Dr. Cicely Saunders first articulated her ideas
about modern hospice care in the United States in
1963 during a visit with Yale University
• She advocated that only an interdisciplinary team
could relieve the “total pain” of a dying person in
the context of his or her family, and the team
concept is still at the core of palliative care today.
 WHO definition of Palliative care
Palliative care:
 provides relief from pain and other distressing symptoms
 affirms life and regards dying as a normal process
 intends neither to hasten or postpone death
 integrates the psychological and spiritual aspects of patient
care
 offers a support system to help patients live as actively as
possible until death
 See:http://www.who.int/cancer/palliative/definition/en/.
 WHO definition of Palliative care c.t.d
 offers a support system to help the family cope during the
patients illness and in their own bereavement
 uses a team approach to address the needs of patients and
their families, including bereavement counseling, if indicated
 will enhance quality of life, and may also positively influence
the course of illness
 is applicable early in the course of illness, in conjunction with
other therapies that are intended to prolong life, such as
chemotherapy or radiation therapy, and includes those
investigations needed to better understand and manage
distressing clinical complications.
 What PaIIiative care does
• Affirms life: Palliative care sustains the quality of life
throughout sickness, helping patients cope with the
struggles of disease.
• Promotes Quality of life: Palliative care helps patients
manage the symptoms of their disease and allows
them to continue with their daily lives.
• Treats the person: Palliative care offers a wide range of
help to patients, including assistance from pharmacists,
nurses, nutritionists, and social workers.
• Supports the family: Palliative care provides a network
of people who can help a patient and their family
better understand treatment options; thus alleviating
much of the stress surrounding illness.
 Indications for palliative care
 Individuals struggling with various diseases

 Individuals with chronic diseases such as;

o cancer
o cardiac disease
orenal failure
o Alzheimer's
oHIV/AIDS e.t.c
 Is Palliative care “Treatment”
• Not exactly
• Palliative care focuses on reducing the
prominence and severity of symptoms rather
than working to “postpone or stop the spread
of a disease.”
• Treatment= “postpone or stop the spread of a
disease.”
What is the Goal of Paliative care?
 The goal is to improve the quality of life for
individuals who are suffering from severe
diseases.

 Palliative care offers a diverse array of

assistance and care to the patient
 Example
• Sara is diagnosed with breast cancer and is recommended
to start chemotherapy and radiation treatments.
• She knows that chemotherapy will take a toll on her body.
• Sara is referred to a palliative care program for symptom
management and receives treatment of her chemotherapy
induced nausea and fatigue.
• A specially trained nurse visits her to help make good
medical decisions.
• She may if wishes be visited by a chaplain or a Sheikh to
pray with her and discuss theological questions.

• In this way the quality of life for her is greatly improved

from the assistance received from this palliative care team.
 Palliative care and cancer
 Roughly about 7.5 million people worldwide die from cancer each
year.

 More than 70% of all cancer deaths occur in developing countries,

where resources available for prevention, diagnosis and treatment
of cancer are limited or nonexistent.

 More than 40% of all cancers can be prevented. Others can be

detected early, treated and cured. Even with late-stage cancer, the
suffering of patients can be relieved with good palliative care.
 Palliative care is given throughout a patient’s experience with
cancer.
 Care can begin at diagnosis and continue through treatment,
follow-up care, and the end of life.
 Palliative care is tailored
• It is definitely not a “one size fits all approach”
• Care is tailored to help the specific needs of the
patient
• Since palliative care is utilized to help with various
diseases, the care provided must fit the symptoms
• Symptoms and concerns are varied such as “pain,
fears about the future, loss of independence,
worries about their family, employment, costs
where there is no insurance cover, some
unfinished tasks,and feeling like a burden.”
 Palliative Care Patient Support Services
Three categories of support:
1. Pain management is vital for comfort and to reduce
patients’ distress. Health care professionals and
families can collaborate to identify the sources of
pain and relieve them with drugs and other forms of
therapy.
2. Symptom management involves treating symptoms
other than pain such as nausea, weakness, bowel and
bladder problems, mental confusion, fatigue, and
difficulty breathing
3. Emotional and spiritual support is important for
both the patient and family in dealing with the
emotional demands of critical illness.
 What does palliative care offer to the
patient?
• Helps patients gain the strength and peace of
mind to carry on with daily life
• Aid the ability to tolerate medical treatments
• Helps patients to better understand their
choices for care
 Killing an let die
• Palliative care offers quality of life
• But what happens when there is too much
suffering?
• First lets attest firmly that:” Nothing and no one
can in any way permit the killing of an innocent
human being, whether a fetus or an embryo, an
infant or an adult, an old person, or one suffering
from an incurable disease, or a person who is
dying.”
 Killing an let die
• Then on what basis are we permitted
to stop treatment by turning off the
respirator of a permanently
comatose, but alive, patient?
• The distinction between commission
and omission is at stake here.
 Killing an let die
• It is a difficult task in the debate about euthanasia to define
with precision the moral difference between commission
and omission or between active killing and allowing to die.
• First of all, both ways of bringing about death involve moral
decisions followed by obvious physical action, for instance,
turning off a respirator, removing an intravenous tube
• We will use these terms, “killing” and “allowing to die” or
“letting die” on EUTHANASIA in the next lecture.