Introduction to Palliative Care Attachment What

Introduction to Palliative Care Attachment

What do you think palliative is? What is your experience of palliative care? What is your experience of death and dying? Personal experience?

Learning objectives Understand Terms “palliative care”, “end of life care”, “life-limiting illness” and “terminal illness”. Range of palliative care patients with cancer and other conditions. When specialist palliative care services should be involved The potential need for palliative care concurrent with active disease management. Demonstrate appropriate attitudes towards: Personal emotional impact of palliative care on themselves and colleagues. Personal limitations and asking for help and support. Sources of help in dealing with personal and professional issues.

What is Palliative Care? What do these terms mean Palliative care Palliative chemotherapy Palliative surgery End of life care Life-limiting illness Terminal

What is Palliative Care? Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. WHO Definition

WHO definition 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; 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 counselling, 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 otherapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand manage distressing clinical complications.

Why is Palliative Care important? One thing certain in life and that is death All doctors will experience dying patients A “good death” should be the norm

A Good death? What do we mean? Is there ever a good death?

Defining a good death Am J Geriatr Psychiatry 24: 4, april 2016 1. Preference for dying process 1. 2. 3. 2. Pain free 1. 2. 3. Death scene (how, who, where, when) Dying during sleep Preparation for death (e. g. Advanced directives, funeral arrangements) Not suffering Pain and symptom management Emotional well being 1. 2. 3. Emotional support Psychological comfort Chance to discuss meaning of death

4. Family 1. 2. 3. Family support Family acceptance of death Family is prepared for death 5. Dignity 1. 2. Respect as an individual Independence 6. Life completion 1. 2. 3. Saying goodbye Life well lived Acceptance of death

7. Religiosity/spirituality 1. 2. 3. Religious/spiritual comfort Faith Meet with clergy 8. Treatment preference 1. 2. 3. Not prolonging life Belief that all available treatments were used Control over treatments 9. Quality of life 1. 2. 3. living as usual Maintaining hope, pleasure, gratitude Life is worth living

10. Relationship with HCP 1. 2. 3. Trust/support/comfort from physician/nurse Physician comfortable with death Discuss spiritual beliefs 11. Other 1. 2. 3. 4. recognition of culture Physical touch Being with pets Heath-care costs

Wagon wheel

Wagon wheel physical practical psychological Disease Social patient spiritual family

Randy Pausch ‘The last lecture’ “Time is all you have. . . and you may find that one day you have less time then you think. ”

“A society will be judged on the basis of how it treats its weakest members and among the most vulnerable are surely the unborn and the dying” – Pope John Paul II

What is different about our specialty?

http: //www. bbc. co. uk/programmes/p 02 dhx 8 c

What can Palliative Care do for you? “once you learn how to die, you learn how to live” - Mitch Albom, Tuesdays with Morrie: An Old Man, a Young Man, and Life's Greatest Lesson

What can Palliative Care do for you? “Giving to other people makes me feel alive. Not my car or my house. Not what I look like in the mirror. When I give my time, when I can make someone smile after they were feeling sad. . . ” ― Mitch Albom, Tuesdays with Morrie

Paul Kalanithivideo

What are patients choices at the end of life? Patient centred care What is available to help patients die at home? What framework to support end of life care provision.

Specialist versus generalist What is the difference When should patients be referred for specialist care

Empathy Hidden curriculum cognitive/affective empathy Cost of caring video

Dealing with the dying -how do we cope? Personal impact Being aware of your limitations Where do you get help?

Holistic care vs medical culture

‘One chance to get it right’

Overview Spend 2 weeks in Palliative care which is divided into designated pathway weeks 1 week at the hospice 1 week in the community and the hospital Each week you’ll clerk a patient, which is the basis of the weekly formative clinical feedback session led by the palliative care doctors

St Luke’s Hospice Website General info Timetables & Learning Objectives for each week E-ELCA Registration Instructions APM Undergraduate Syllabus Admission Pro-forma & Guidelines Links to online palliative care resources https: //www. stlukes-hospice. org. uk/palliative-education

Palliative Care Education Website www. pallied. com

What do you expect for the next 2 weeks? What are your aims? 5 aims for the next 2 weeks

Take home messages Read through St Luke’s Hospice medical student section – timetable, learning objectives Register on E-ELCA for e-learning Use the Admission Pro-forma to clerk and present patients for each pathway week Think about the patho-physiology behind symptoms Use palliative care guidelines website as your all in one palliative care resource

Finally… We’re here to help – can be a emotionally difficult, personal bereavements – please let us know Any Questions?