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PALLIATIVE CARE

PALLIATIVE CARE

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PALLIATIVE CARE

  1. 1. Dr. Kanhu Charan Patro M.D,D.N.B[RT],P.D.C.R,C.E.P.C,FAROI [EX – TATA MEMORIAL HOSPITAL] Consultant- Radiation Oncology MAHATMA GANDHI CANCER HOSPITAL VISAKHAPATNAM Email-drkcpatro@gmail.com ,M-09160470564 PALLIATIVE CARE AND RADIATION PROSPECTIVE
  2. 2. Emperor –THE ASHOKA [273 BC-232BC]
  3. 3. What is Palliative Care?  The WHO describes palliative care as "an approach that improves the QOL of patients and their families facing the problems 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."
  4. 4. 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;
  5. 5.  Uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated;  Will enhance QOL, and may also positively influence the course of illness;  Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
  6. 6. GOAL  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.
  7. 7. History  Started as a hospice movement in the 19th century, religious orders created hospices that provided care for the sick and dying in London and Ireland.  In recent years, Palliative care has become a large movement, affecting much of the population.  Began as a volunteer-led movement in the United states and has developed into a vital part of the health care system.
  8. 8. 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.
  9. 9. PALLIATIVE CARE IS NOT HOSPICE
  10. 10. Hospice Palliative Care All hospice care is palliative, but not all palliative care is hospice
  11. 11. Palliative vs. Hospice  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. 12. Who needs?  Individuals struggling with various diseases  Individuals with chronic diseases such as cancer, cardiac disease, kidney failure, Alzheimer's, HIV/AIDS and Amyotrophic Lateral Sclerosis (ALS)
  13. 13. Cancer and Palliative Care  It is generally estimated that roughly 7.2 to 7.5 million people worldwide die from cancer each year.  More than 70% of all cancer deaths occur in developing countries, where resources available for prevention, diagnosis and treatment of cancer are limited or nonexistent.  More than 40% of all cancers can be prevented. Others can be detected early, treated and cured. Even with late-stage cancer, the suffering of patients can be relieved with good palliative care.
  14. 14. Palliative Care and Cancer Care  Palliative care is given throughout a patient’s experience with cancer.  Care can begin at diagnosis and continue through treatment, follow- up care, and the end of life.
  15. 15. Palliative Care and Cancer  "Everyone has a right to be treated, and die, with dignity. The relief of pain - physical, emotional, spiritual and social - is a human right," {said Dr Catherine Le Galès-Camus, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health.}  "Palliative care is an urgent need worldwide for people living with advanced stages of cancer, particularly in developing countries, where a high proportion of people with cancer are diagnosed when treatment is no longer effective."
  16. 16. BY WHOM  Usually provided by a team of individuals  Interdisciplinary group of professionals  Team includes experts in multiple fields:  Doctors  Nurses  social workers  massage therapists  Pharmacists  Nutritionists
  17. 17. Patient and Family Volunteers Physicians Spiritual Counselor s Social Workers Pharmacist s Home Health Aides Therapis ts Nurses
  18. 18. 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.
  19. 19. 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.
  20. 20. Palliative Care Patient Support Services 2. Symptom management involves treating symptoms other than pain such as nausea, weakness, bowel and bladder problems, mental confusion, fatigue, and difficulty breathing
  21. 21. Palliative Care Patient Support Services 3. Emotional and spiritual support is important for both the patient and family in dealing with the emotional demands of critical illness.
  22. 22. 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
  23. 23. What Does 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
  24. 24. Approaches to Palliative Care A palliative care team delivers many forms of help to a patient suffering from a severe illness, including :  Close communication with doctors  Expert management of pain and other symptoms  Help navigating the healthcare system  Guidance with difficult and complex treatment choices  Emotional and spiritual support for the patient and their family
  25. 25. Where?  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.  The Palliative Care Provider Directory of Hospitals at www.getpalliativecare.org can locate hospitals which provide palliative care.
  26. 26. Settings for Palliative Care  Outpatient practice  Hospital Inpatient  Unit based  Consultation Team  Home care  Nursing Home  Hospice
  27. 27. Cost of Palliative Care  Most insurance plans cover all or part of the palliative care treatment given in hospitals.
  28. 28. Palliative Care is Growing  Data suggest there is growth in palliative care programs throughout the nation's hospitals, larger hospitals, academic medical centers, not-for-profit hospitals, and VA hospitals are significantly more likely to develop a program compared to other hospitals.
  29. 29. Pain Problems  Route of administration  Non drug methods  Neuropathic pain  Bone pain  Incident pain  Visceral pain  Anaesthetic techniques
  30. 30. Respiratory Symptoms  Breathlessness  Cough  Haemoptysis  Stridor  Pleural pain
  31. 31. GI Problems  Nausea and vomiting  Obstruction  Constipation  Anorexia  Cachexia  Diarrhoea
  32. 32. Emergencies  Some acute events should be treated as emergencies if a favourable outcome can be achieved.  Hypercalcaemia  SVC obstruction  Spinal cord compression.
  33. 33. Impact on patient with terminal diagnosis “ Suffering” • Physical • Spiritual • Emotional • Psycho-social
  34. 34. Palliative care is not about whether to treat or not to treat but about what is the best treatment
  35. 35. • Hospice (home, hospital) • Hospital based consult service or unit • Clinic • Home consultation • Palliative home health programs DELIVERY OF PALLIATIVE CARE
  36. 36. 53% of Americans die in hospitals
  37. 37. • Relieves pain and other symptoms • Supports re-evaluations of goals of care and difficult decision-making • Improves quality of life, satisfaction for patients and their families • Helps patients complete life prolonging treatments Palliative Care Improves Quality
  38. 38. You are not allowed eat
  39. 39. Oro-cheek fistula
  40. 40. Tracheo-esophageal fistula
  41. 41. Water bed-air bed
  42. 42. Wheel chair
  43. 43. Palliative rehabilitation
  44. 44. Massage
  45. 45. Counseling and giudence 2/9/2021 47
  46. 46. Emotional help 2/9/2021 48
  47. 47. METASTASIS -please do not watch crying 50
  48. 48. 10/20/12 01:12 PM 51
  49. 49. METASTASIS- give a smiling death 52
  50. 50. Palliative radiation Skeletal X-Ray Bone scan MRI PET-CT
  51. 51. Spinal metastasis 54
  52. 52. 55
  53. 53. Brain metastasis 56
  54. 54. 57
  55. 55. Whole brain radiotherapy 58
  56. 56. Choroidal metastasis 59
  57. 57. Superscan-extensive bone mets 60
  58. 58. Hemibody radiation 61
  59. 59. Prophylactic radiation 62
  60. 60. svco 63
  61. 61. CAUTION C - Change in bowel or bladder habits A - A sore that does not heal U - Unusual bleeding or discharge T - Thickening or lump in the breast or any part of the body I - Indigestion or difficulty swallowing O - Obvious change in a wart or mole N - Nagging cough or hoarseness
  62. 62. Change in bowel habits 10/20/12 01:12 PM 65
  63. 63. Change in bladder habits 10/20/12 01:12 PM 66
  64. 64. A sore that does not heal 10/20/12 01:12 PM 67
  65. 65. Unusual bleeding or discharge 10/20/12 01:12 PM 68
  66. 66. Thickening or lump in the breast or any part of the body 10/20/12 01:12 PM 69
  67. 67. Indigestion or difficulty swallowing 10/20/12 01:12 PM 70
  68. 68. Obvious change in a wart or mole 10/20/12 01:12 PM 71
  69. 69. Nagging cough or hoarseness 10/20/12 01:12 PM 72
  70. 70. Prevention-passive smoking
  71. 71. Liver cancer- hepatitis B vaccine
  72. 72. Cervix cancer vaccine 10/20/12 01:12 PM 79
  73. 73. Promise-Stop drinking alcohol 10/20/12 01:12 PM 80
  74. 74. RELAX
  75. 75. Meditation 10/20/12 01:12 PM 82
  76. 76. 83 Dietary protective factors
  77. 77. Breast feeding
  78. 78. REGULAR CHECK-UP
  79. 79. 10/20/12 01:12 PM 86
  80. 80. 88
  81. 81. Physical activity
  82. 82. 90
  83. 83. 91
  84. 84. 10/20/12 01:12 PM 92
  85. 85. 10/20/12 01:12 PM 93
  86. 86. Just “Doing It” is not good enough ! You must know “what” to do and “where” to do it ! 10/20/12 01:12 PM 94
  87. 87. 10/20/12 01:12 PM 95
  88. 88. 10/20/12 01:12 PM 96
  89. 89. 10/20/12 01:12 PM 97 Whenever not possible, make friends
  90. 90. 98 10/20/12 01:12 PM
  91. 91. 99 10/20/12 01:12 PM
  92. 92. 100 ?
  93. 93. THANKS

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