Introduction to palliative care

Introducing the concept of palliative care to undergraduate medical students. WHO definition, concept of total pain and basic pain management

1. Introduction to Palliative Care Dr Tan Chai Eng Department of Family Medicine, UKM 10/9/2014

2. Pre-lecture activity (5 mins ) What do you understand about palliative care? Write or draw your answer Label it as ‘pre-lecture’ Keep it with you until the end of the lecture

3. Why do I need to learn this?

4. Short videos Life before Death: What is palliative care? Care beyond cure?

5. 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 . http://www.who.int/cancer/palliative/definition/en/

6. Why “Palliative Care”? Access to palliative care is a human right . Great need, limited resources Even healthcare professionals may have limited awareness or knowledge of palliative care!

7. Myths and misconceptions Palliative care is only for those who are dying Palliative care is only for those who have no chance for cure Palliative care means giving up hope Patients who choose palliative care die faster Pain relief from palliative care creates addiction http://medhealthwriter.com/palliative-care/top-10-myths-of-palliative-care/

8. What would you choose if you had a life-limiting illness? Why do doctors die differently? Ken Murray, 2011 Gallo, 2003

9. So, what actually does palliative care do? Recognising symptoms such as pain, nausea, fatigue, breathing or swallowing difficulties, constipation, and hopelessness. Identifying the patient's goals and needs so a palliative care plan can be developed specially for the patient. Understanding that many patients and their families struggle to make decisions. We help to facilitate difficult conversations between all parties so that trust can be established and relationships strengthened. Assisting with advanced care directives to help people formulate and communicate their preferences regarding care during future incapacity. It must be understood, however, that euthanasia cannot be accepted as part of palliative care. http://www.palliativecare.my/about

10. Palliative care provides relief from pain and other distressing symptoms

11. Pain is not just physical…

12. Common symptoms in palliative care

13. Palliative care affirms life and regards death as a normal process I am not afraid of death, but I am afraid of suffering…

14. Palliative care intends neither to hasten or postpone death Treatment aims not for cure, not for prolonging life Treatment aims to reduce suffering

15. Palliative care integrates the psychological and spiritual aspects of patient care Family conference, welfare referrals Pastoral care Appropriate use of analgesics, symptom relief Antidepressants, supportive psychotherapy, CBT

16. Palliative care offers a support system to help patients live as actively as possible until death Katie Kirkpatrick 2005 http ://www.weddinggirl.ca/blog/weddingthemes/wedding-cancer-story / Hospis Malaysia, OT

17. Palliative care offers a support system to help the family cope during the patients’ illness and in their own bereavement

18. Palliative care uses a team approach to address the needs of patients and their families Multi-disciplinary care to provide comprehensive care for patients

19. Palliative care will enhance quality of life, and may also positively influence the course of illness Stories and testimonies of patients and their families who received palliative care at http://www.palliativecare.my/testimonials

20. Palliative care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life

21. What is needed? Multidisciplinary approach Good clinical assessment Judicious use of investigations Fulfill information needs Facilitate decision making Communication skills Psychosocial problems Care for caregivers

22. Pain management

23. Other common symptoms Common symptoms Possible pharmacological treatment Nausea and vomiting Metoclopramide , prochlorperazine , haloperidol, granisetron Dyspnoea , cough Morphine, codeine, prednisolone , salbutamol Anorexia, cachexia Treating is controversial . Steroids, medroxyprogesterone , megestrol Fatigue Constipation Bisacodyl , senna , lactulose , enemas Diarrhoea Loperamide , Lomotil , codeine

24. Other common symptoms Common symptoms Possible pharmacological treatment Intestinal obstruction Haloperidol, hyoscine , octreotide Depression SSRI, benzodiazepines Malignant ulcers (foul odour ) Metronidazole tablets Minor bleeding Tranexamic acid Oral health issues Oral hygiene, xylocaine viscous, bonjela

25. Non-pharmacological Physiotherapy Occupational therapy Massage Music

26. Community Palliative Care Available mainly in urban areas Delivered by palliative care nurses and doctors, other allied health professionals Allows patients to die at home Provides nursing and medical care, symptom control, information, practical advice, equipment loan, carer support, preparation for death

27. Community Palliative Care Shared care with primary clinician GPs can play a major role in areas with no community palliative care services http://www.palliativecare.my /

28. Types of palliative care All healthcare professionals! Additional training Specialised settings, hospice

29. Post-lecture activity (5 mins ) Write down / draw a picture to explain what palliative care means to you now. Label it “after lecture” Compare it with your first picture Has it changed?

30. Reflections Write a short paragraph on what palliative care means to you. Submit to Dr Tan’s pigeonhole at Department of Family Medicine, 14 th floor, Preclinical Block, UKMMC.

31. For your reading pleasure…

32. THANK YOU