IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

CONTENTS AND
UNDERSTANDING OF T H E
PRESENTATION :
 An approach to the terminally ill – a learners point of view.
 Understanding basics of palliative care.
 How does it influences the life of a patient and his
care givers.
 Domains and concerns of palliative care
 How does or how should this learning influence you.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 PRESENTATION

A BASIC UNDERSTANDING
OF TERMINAL STAGE,
UNDERSTANDING BASIC
DEATH AND BEREAVMENT
PALLIATIVE CARE
CONSIDERING BOTH THE
PATIENT AND FAMILY
MEMBERS

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 This is how we look at
life.
We expect it
to just go on and on.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 But…
what if there is a chronic
disease?

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 Fortunately, medicine today can
help us recover and
keep us comfortable.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 However, at times
medicine cannot
stop the progress
of the disease.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

What! A m How
I serious? long do
I What
have? will
h a ppen
to my
fa m i ly ?

When the doctor

indicates the end is near,
the patient finds it
difficult to believe
…

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 T h e r e is

n o th in g What
Are y o u you do
sure? ca n do? we
do?

… so does the
family.
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
 Is i t
rude to Wi l l t h e
ask Doctor ask
the my question
d o c to r ?

The patient and the I k n o w best,

W h a t if so w h y ask ?
my family must feel free
qu estion to share their fears
is silly?
and concerns
with the doctor.
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
This is the time for some honest communication,
the time to take some decisions together.
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
No pain, no distress to
the patient at any time.

Always respect the

patient’s dignity, likes
and the right to make
decisions.

Allow the patient to

express preferences
about end-of-life care.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 I want
to die
No life at I want
home. m y wife
support near me
for m e when I
please die.

Te l l m y I want
friend to t h e priest
f o rg iv e
It is important to to help
me. honour the m e p r a y.
patient’s
wishes.
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
Apart from pain & comfort care,
end- of-life care provides:
 psychological,
 spiritual and
 social support.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 Life eventually
ends, but end-of-
life care does
not.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 Bereavement
support helps the
family cope and
start afresh.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 End-of-life care is about never stopping to
care, even when we cannot cure.

“Never say ‘I can not do any thing

more’, Always say ‘I can do some
thing more’”

Because there is always something more that

we can do.

“Never say No”

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

The care with which we treat the dying affirms
that our humanity is living.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

Together we
choose.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
Definition:
Palliative Care is an approach that improves the quality of life of
patients and their families facing the problems associated with
life-threatening illnesses, through the prevention and relief
of suffering by means of
• early identification,
• impeccable assessment and
• treatment of pain and other problems, physical, psychosocial
and spiritual.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

REF: WORLD HEALTH ORGANISATION / PALLIATIVE CARE
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
The Palliative Care approach aims to promote physical,
psychosocial and spiritual well-being.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

Good quality palliative care can be defined as the care,
which I would be happy to have given to a member of my
own family if he or she was dying, or to receive myself
when my time comes.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 History of palliative care
 Palliative care is not new.

 Care of the dying has been a constant

feature of human society throughout the
history.

 We have ancient traditions in India of

looking after those who are dying with
special care and attention.

 The Eighteen institutions built in India

Kingby Asoka (273 – 232 BC) had
characteristic very similar to
s
hospices. He hadmodern
even established a refuge
for the dying in near the sacred river
Varanasi

Ganges.
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
[REF: HANDBOOK FOR CERTIFICATE COURSE IN ESSENTIALS OF PALLIATIVE CARE;REVISED FOURTH EDITION 2015]
 Dame Cicely Mary Saunders
 Best known for her role in the birth of the
hospice movement, emphasizing the
importance of palliative care in modern
medicine.

 She was a prominent Anglican, nurse,

physician and writer, involved with many
international universities.

 She helped the dying and terminally ill end

their lives in the most comfortable ways
possible .

 She developed the first ever hospice “St

Christopher’s Hospice” in 1948
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
[REF: HANDBOOK FOR CERTIFICATE COURSE IN ESSENTIALS OF PALLIATIVE CARE;REVISED FOURTH EDITION 2015]
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
 PALLIATIVE CARE:
A MULTI DISCIPLINARY & MULTI FOCUSED APPROACH

 Empathetic
 Hospice care
 Death autonomy
 Clear decisions
 Breaking bad news
 Poly pharmacy
 Holistic approach
 Total pain

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
 Understanding pain: touch – healing – active
listening – mind shift –presence of near & dear
ones.

 Avoiding unnecessary interventions

 Respecting ones will

 Not letting the sufferer feel underprivileged

 Treating and caring more through the heart than

through the mind (brain)

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 PROBLEM
SCENARIO
 With a crude death rate of 6.24/1000 and a population of more
than a billion, the total number of people dying every year in
India is about seven million.
 More than 4 million of them would benefit from palliative care.
 But only Less than 1% of those who need palliative care services
have any access to such services in the country.
 Kerala is the only state in India to have medical and legislative
norms to provide palliative care to the needy.

IAPC | TOGETHER WE CHOOSE 2014 | ISCCM

 The present medical establishment, with its hospital-
centred services, is geared basically to look after patients
with acute illness.
 This acute-care orientation is reflected in the current
emphasis on illness diagnosis, patient-initiated
consultations, and curative and/or symptom relieving
treatments.
 Patients with chronic and incurable illness on the other
hand need a regular system of support available in the
community.
IAPC | TOGETHER WE CHOOSE 2014 | ISCCM
How should this presentation help
you ???
* You should have a more empathetic attitude
towards the sufferer.

*We must understand that caring doesn't end with the death of the
patient.

* Care should be by involving family and other health associates.

* Pain is not just physical, its more of the mind.

* A fundamental understanding of WHO pain ladder.

* Judicious use of analgesics.

* Palliative care is / can be given along with other on going

therapies.

* And PLAN YOUR DEATH–DEATH AUTONOMY/DEATH WILL.

KEY POINTS TO
REMEMBER:
 Palliative care is not necessarily for the terminally ill
 It is not only for cancer patients
 Morphine is the best analgesic to be given for refractory pain
management cases / for severe unbearable pain
 Oral morphine is effective than I.V
(Morphine doesn't causes addiction, respiratory distress or any
major adverse effects)
 Palliative medicine is a community approach.
 Palliative care affirms dignity at end of life and ensures
bereavement care.
Ultimately, the goal is to do what is good for the
patient and as life is drawing to a close, to lead him
towards a ‘good’ or peaceful death.

A good death is achieved when:

•The patient’s pain and other physical symptoms have been
adequately controlled
• The patient has had time to
- Evaluate his Life Journey
- Review his achievements and failures
- Forgive and ask for forgiveness
- Reconcile with self, family and God
- Say ‘I love you’
- Accept death and be ready to say ‘Good Bye’
Plan your life so that you can live
fully.
Plan your death so that you can die
peacefully.