palliative care and hospice

1. Palliative
Care

3.  Medical care that focuses on alleviating the
intensity of symptoms of disease.
 Palliative care focuses on reducing the
prominence and severity of symptoms.
APEX HOSPITAL’S
INITIATIVE
PAIN CLINIC

4. WHAT IS PALLIATIVE
CARE?
 Medical care that focuses on alleviating the
intensity of symptoms of disease.
 Palliative care focuses on reducing the
prominence and severity of symptoms.

5. WHO DEFINITION OF
PALLIATIVE CARE
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;

6.  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.

7. Why needed?

8. Why needed?

9. What is the goal of
Palliative Care?
 The goal is to improve the quality
of life for individuals who are
suffering from severe diseases.
 Palliative care offers a diverse
array of assistance and care to
the patient.

10. Palliative vs. Hospice
Care
• Division made between these two
terms in the United States
• Hospice is a “type” of palliative care
for those who are at the end of their
lives.
Image courtesy of
http://www.ersj.org.uk/content/32/3/796.f
ull

11. Palliative vs. Hospice
Care
• Palliative care can be provided
from the time of diagnosis.
• Palliative care can be given
simultaneously with curative
treatment.
• Both services have foundations in
the same philosophy of reducing
the severity of the symptoms of a
sickness or old age.

12. Who receives
Palliative Care?
Individuals with chronic diseases
such as
 Cancer
 cardiac disease
 kidney failure
 Alzheimer's
 HIV/AIDS
 Amyotrophic Lateral Sclerosis
(ALS)

13. Who Provides
Palliative Care?
 Usually provided by a team of
individuals , Interdisciplinary group
of professionals

14. Patient
and
Family
Volunteers
Physicians
Spiritual
Counselors
Social
Workers
Pharmacists
Home
Health
Aides
Therapi
sts
Nurses

15. Approaches to
Palliative Care
• Not a “one size fits all approach”
• Care is tailored to help the
specific needs of the patient
• Since palliative care is utilized to
help with various diseases, the
care provided must fit the
symptoms.
Image courtesy of uwhealth.org

16. Palliative Care Patient
Support Services
 Three categories of support:
1. Pain management is vital for
comfort and to reduce patients’
distress. Health care professionals
and families can collaborate to
identify the sources of pain and
relieve them with drugs and other
forms of therapy.

17. 2. Symptom management
involves treating symptoms other
than pain such as nausea,
weakness, bowel and bladder
problems, mental confusion,
fatigue, and difficulty breathing

18. 3. Emotional and spiritual
support is important for both the
patient and family in dealing with
the emotional demands of critical
illness.

19. What does Palliative Care
Provide to the Patient?
• Helps patients gain the strength
and peace of mind to carry on
with daily life
• Aid the ability to tolerate medical
treatments
• Helps patients to better
understand their choices for care

20. What does Palliative Care
Provide to the Patient?
• Helps patients gain the strength
and peace of mind to carry on
with daily life
• Aid the ability to tolerate medical
treatments
• Helps patients to better
understand their choices for care

21. What Does Palliative Care
Provide for the Patient’s
Family?
 Helps families understand the
choices available for care
 Improves everyday life of patient;
reducing the concern of loved ones
 Allows for valuable
support system

22. Where to find Palliative
Care?
• In most cases, palliative care is
provided in the hospital.
• The process begins when doctors
refer individuals to the palliative
care team.
• In the hospital, palliative care is
provided by a team of experts.

23. Settings for Palliative
Care
 Outpatient practice
 Hospital Inpatient
 Unit based
 Consultation Team
 Home care
 Nursing Home
 Hospice

24. Uses of
Radiotherapy in
palliative care

25. BONE METS
• Frequently arise from
• breast, prostate (combined = 80% of
incidence)
• lung, kidney, thyroid, multiple
myeloma, gastrointestinal
• Pain may be due to
• Bone changes
• Pathological fracture
• Neuropathic pain if presses on
adjacent nerve
• Spinal cord compression

26. SPINAL CORD
COMPRESSION

27. SPINAL CORD COMPRESSION

28. HOW DOES IT WORKS??
• Cytotoxic effect on normal bone cells
inhibits the release of chemical
mediators of pain such as prostaglandins
• Some patients get relief in 24 hours
• Effect on cancer cells prevents further
bone destruction, reduces tumour size
and enables bone resorption
• The pain relief effect achieved
between 2 and 8 weeks of treatment

29. BRAIN METS

30. SUPERIOR VENA CAVA
SYNDROME
• A: Plethora of face and neck.
• B: Distended jugular veins.
• C: Cyanosis of the lips.
• D: Right arm and hand massively swollen.
• E: Substantial collateral circulation (arrow).
• F: Computed tomogram shows compression of the superior
vena cava (arrow) due to a large mediastinal mass, causing (F Ј )
tracheal compression and deviation, and stridor.

32. FULL FLEDGED PALLIATIVE
SET-UP WITH HOSPICE

33. • DEPARTMENT OF RADIATION
ONCOLOGY
• Dr Ankita Patel(DIRECTOR)(MD
Radiation Oncology)
• Dr Neha Gupta(MD Radiation
Oncology)
• Dr CP Verma(MD Radiation
Oncology)

34. • DEPARTMENT OF MEDICAL
ONCOLOGY:
• Dr Abishek Kumar Singh(DNB
Medical Oncology)

35. • DEPARTMENT OF SURGICAL
ONCOLOGY
• Dr Anurag Dixit(MS,Fellowship in
oncology)
• Dr Sandeep Kumar(MS,Mch
Surgical Oncology)
• Dr Swaroop
Patel(DIRECTOR)(Bone and Soft
tissue Oncology)(MS ORTHO)
• Dr Akhil
Sareen(MS,ENT,HNNOnco
fellowship)
• Dr PK Keshari(Mch, Uro-Surgeon)
• Dr L K Pandey (MS,Gynae ans
Obs)

36. • ANAESTHETIST TEAM
• Dr Rakesh(MD ,Anaesthesia)
• Dr Umesh (MD ,Anaesthesia)
• Dr Arvind(MD ,Anaesthesia)
• Dr Abhishek Singh(Diploma,
Anaesthesia)
• Nerve blocks and patient controlled
analgesia

37. • DEPARTMENT OF NUCLEAR
MEDICINE
• Dr R S Meena (MD, Nuclear
Medicine)
• Dr Saumya Agarwal Balja(DNB,
Nuclear Medicine)
• Our NUCLEAR MEDICINE services
include
PET-CT Scanner(GE)
GAMMA SCAN
Bone scan
Renal scan
Stress myocardial perfusion scan
Parathyroid scans
Brain SPECTS
Ventilation perfusion scans
Radioiodine Probe

38. • CATHETER CARE
• CHEMOPORT INSERTION
• Dr Amit Srivastava (Mch CTVS)
• PICC PLACEMENT
• Dr Rakesh (MD,ANAESTHESIA)
• DEPARTMENT OF DIETETICS
• Ms Neha Dubey
• Ms Neha Chaubey

39. • OCCUPATIONAL THERAPY
DEPARTMENT
• Dr U K Singh
• Dr Manoj Pandey
• Dr Ruchi Singh
• Dr Akshay Dixit
• Dr Arpita
• PATIENT AND FAMILY
COUNCELOR
• Ms Sarita Singh

40. • OCCUPATIONAL THERAPY
DEPARTMENT
• Dr U K Singh
• Dr Manoj Pandey
• Dr Ruchi Singh
• Dr Akshay Dixit
• Dr Arpita
• PATIENT AND FAMILY
COUNCELOR
• Ms Sarita Singh

41. THANK-YOU