WHY oriented palliative concept

&
End of life care

Patama Gomutbutra MD.

Chiang Mai university
 End of
life care
?
“Palliative care”
End of life care
Palliative care
?
Palliative care End
of life care
?
?
Simon’s Golden cycle

Aim

Action

Assessment
 Buddhism wisdom

Palliative care:
End of life care: Care for good
Care for.. life
good death
 WHY oriented palliative concept

Wish
(Spiritual)

Prognosis time frame

You, team, family, community

management
Caregiver capacity:

Illness
(Symptom)
management

Disease
(System)
management
Gomutbutra 2012
 Wish management
Why:
1. Focus energy in realistic hope
2. Prepare for uncertainty

How :
1. Patient centered interview
2. Prognosis & clinical assessment
3. Team & family meeting
What :
1.Acceptance sign:
- clear goal, co-operation ?
- No need “yes I have cancer”
2. Finish business task
 Illness management
Why:
1. Optimum pain, dyspnea control
2. Prevent complication from distress

How :
1. Prognosis & Clinical assessment
2. Patient centered interview
3. Team & family meeting

What :
1. Symptom score
2. Function
 Disease management
Why:
1. Less caregiver burden (include us)
2. Less suffering from futile treatment

How :
1. Team & Family meeting
2. Prognosis & Clinical assessment
3. Patient centered interview

What :
1. Caregiver (include us) well being
2. Less emergency visit
?
3. More death at home. Less in ICU
 Comfort care suits
(UCSF Hospital
based hospice)

Home hospice
singapore
 You can fill by yourself ...
• Aims for “Why”
• Actions for “How”
• Assessments for “What”
 Take home message

• End of life care as the shadow of

palliative care :
Expecting “good death” at
anytime

• Start with “WHY”

pgomutbu@med.cmu.ac.th