Chapter 4

Palliative Care (2)

Weiwei Liu (Vivian)

Public Health and Management
Department
 Objectives
• What is palliative care?
• Challenges
• How can palliative care help?
• Hospice Care
• five stages of psychological changes of
the dying patients
1. What is Palliative Care?
• Palliative care seeks:
– to prevent or relieve physical, social,
emotional and spiritual suffering produced by a
life threatening medical condition or its treatment
– to help patients with such conditions and their
families live as normally as possible
– to provide them with timely and accurate
information and support in decision making
 Palliative Care

Holistic Quality
Approach of Life

Lift-threatening &
Patients &
Life-limiting illness
Families

Identification,
impeccable
assessment &
treatment of
symptoms
Goals of Palliative Care
1. to provide relief from pain and other physical
symptoms

2. to maximize the quality of life

3. to provide psychosocial and spiritual care

4. to provide support to help the family during the

patient’s illness and bereavement
 Palliative Care
• IS • NOT
– Evidence based medical – “giving up”
treatment
– “accelerating death”
– Vigorous care of pain
and symptoms through – the same as hospice
illness care
– Care that patients may
want at the same time as
treatment to cure or
prolong life
Ethics of Euthanasia & Natural Death
Difference of Euthanasia and Natural Death
Euthanasia Natural Death
Motivation Relief patient’s pain Relief patient’s pain
Method killing Palliative care could
improve the quality of
life
Patient’s Despair, destroy Cherish the end of life
state themselves period
Religion Be against Naturally, all in favor
Medical Ethics Against to “no harm" In accordance with the
principle “do no harm” principle
Relative’s Regret due to “kill” The patient received
feeling the patient good care, relative
without regret when the
patient die
Palliative Care

Palliative
Medicine

Hospice
 Palliative Care Model
• Old- Abrupt transition to hospice
D
I Disease Palliative D
A
Modifying Therapy E
G
N Therapy A
O
Relief of T
S Prolongation of life H
I Suffering
S
 Palliative Care Model
• Optimal- Continuum of care

Disease
Modifying
Therapy
Palliative Therapy

Presentation Illness End of

Acute Chronic Life Care Death Bereavement
 Who Needs Palliative
Care?
• People of all ages with life-
threatening or debilitating illness
– Children with congenital injuries or
conditions
– Persons with severe trauma
– People living with progressive chronic
illness
 2. Challenges
Patient
• Not legally competent
• Lacks verbal skills to describe
needs, feelings, etc.
• Not achieved a "full and complete
life”

Family
• Difficulty understanding treatment
plans, prognosis, etc.
• Needs relief from burden of care
• Stress on finances
 Challenges
Caregivers
• sense of “failure”
• lack familiarity with
dosages and
medications for
symptom management
• lack experience in
caring for dying patients
3. How Can Palliative Care Help
• Symptom Management
• Hospital Care
• Home Care
• Psychosocial Support
• Bereavement
How is Palliative Care Different from
Curative Care? ( )
Curative Care
(=disease-oriented, restorative)
Be
r ea
ve
m
en
t
Palliative Care
(=supportive, person-oriented)

Diagnosis Dying Death

Person with Illness Support services for

Family families and caregivers
Caregivers
DISEASE PROGRESSION
 4. Palliative Care
Should start at the time of diagnosis
Occurs simultaneously with
aggressive or curative treatments,
often managing symptoms that these
therapies cause
Often underfunded and difficult to
access in many areas
Most often done in the hospital
setting; More community-based
outpatient palliative care services are
beginning to pop up in larger
metropolitan areas but access is still
limited; Nowadays moving into
homecare
VS. Hospice Care
Provided in the last six months of life
Usually cannot be given at the same
as curative or aggressive treatments
such as chemotherapy, radiation
therapy
Paid for in full by the Medicare
benefit and by Medicaid (in most
states)
Most often provides care in a patient’s
home setting, could be at their own
home or that of a relative, a nursing
home or assisted living facility, or
retirement community; Some hospices
offer inpatient services in dedicated
hospice facilities
5. five stages of psychological changes
of the dying patients

1 ． shock and denial

2 ． anger
3 ． bargaining
4 ． depression
5 ． acceptance
 2 3 5
Anger Bargaining acceptance

Why me yeap, it’s I’m ready

for death.
？！ me,
but……

Gradually understand the

Health true consequences More self-sustaining
Stable diease The loneliness, growth

Diagnosis inner guilt

with a
terminal
illness
1 4
Denial depression The psychological
process of dying
It’s impossible Yes, it’s me.
！ You make a patients.
mistake ！
 Summary

The focus of palliative care is the

comfort and well being of the
patient and family.
Thank you!