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Palliative Care
Julianna Tambellini,
Meredith Hennon,
University of Pittsburgh
USA
Image courtesy of fightmesotheliomacancer.com
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.
What is Palliative Care?
 The World Health Organization describes palliative care as
"an approach that improves the quality of life of patients and
their families facing the problems associated with lifethreatening 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 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;
 offers a support system to help patients live as actively as
possible until death;
WHO Definition of Palliative Care (cont.)
 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 counseling, 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
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.
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.
The History of Palliative Care
 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.
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.full
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.
 Other countries do not make such a distinction
Who receives Palliative Care?
 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)
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.
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.
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."
“Cancer Control: Knowledge Into Action”
 Excerpts from the WHO guide for Palliative Care:
“Palliative care is an urgent humanitarian need worldwide
for people with cancer and other chronic fatal diseases.
Palliative care is particularly needed in places where
a high proportion of patients present in advanced stages
and there is little chance of cure.”
Who Provides Palliative Care?
 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
Volunteers
Physicians
Nurses
Therapists
Patient
and
Family
Home Health
Aides
Spiritual
Counselors
Social Workers
Pharmacists
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
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.
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
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.
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
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
Image courtesy of mdanderson.org
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
Palliative Care Is Effective
 Successful palliative care teams require nurturing
individuals who are willing to collaborate with one
another.
 Researchers have studied the positive effects palliative care
has on patients. Recent studies show that patients who
receive palliative care report improvement in:
 Pain and other distressing symptoms, such as nausea or
shortness of breath
 Communication with their doctors and family members
 Emotional and psychological state
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.
 The Palliative Care Provider Directory of Hospitals at
www.getpalliativecare.org can locate hospitals which provide
palliative care.
Settings for Palliative Care
 Outpatient practice
 Hospital Inpatient
 Unit based
 Consultation Team
 Home care
 Nursing Home
 Hospice
Cost of Palliative Care
 Most insurance plans cover all or part of thepalliative care
treatment given in hospitals.
 Medicare and Medicaid also typically cover palliative care.
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.
Palliative Care is Universal
 Numerous governments have already adopted national
palliative care policies, including Australia, Canada, Chile,
Costa Rica, Cuba, France, Ireland, Norway, Spain, Uganda,
South Africa and the United Kingdom.
Palliative Care in WPRO
 The Western Pacific Regional Office (WPRO) represents the
WHO in 37 countries of Asia Pacific.
 About a quarter (25%) of the countries in the WPRO region
have an established system (“approaching integration”) for
palliative care that encompasses the entire country or have
services typically in large cities or highly populated regions
(“localized provision”).
Countries with established systems
 Australia
 In 1987, Ian Maddocks accepted the world’s first Chair in Palliative Care at
Flinders University.
 Palliative care is recognized as a medical specialty in 2005.
 Around 320 palliative care services are operational.
 Japan
 Palliative care standards were first introduced in 1997.
 Palliative care education is included in the curriculum of most medical
schools in the country and all nursing schools.
 120 services related to palliative care are available country-wide.
 Singapore
 13 organizations providing palliative care.
 Palliative care module added to medical school curriculums.
Countries with established systems
 Malaysia
 In 1998, the Government began requiring every district and general hospital
to introduce a palliative care provision.
 Mongolia
 Palliative care incorporated into National health plan.
 Palliative care module included in medical school curriculum.
 New Zealand
 A palliative care education program has been established for care assistants.
 41 services are currently delivering palliative care throughout the country.
Countries with localized provisions
 China
 South Korea
 Philippines
 Vietnam
Countries with building capacity
 Brunei Darussalam
 Fiji
 Papua New Guinea
The countries are aiming to create conditions for the
development of programs focused on palliative care.
Countries with no palliative care
 American Samoa
 Northern Mariana Islands
 Cook Islands
 Palau
 French Polynesia
 Pitcairn Islands
 Guam
 Samoa
 Kiribati
 Soloman Islands
 Laos
 Tokelau
 Marshall Islands
 Tonga
 Micronesia
 Tuvalu
 Nauru
 Vanuatu
 New Calendonia
 Wallis and Futuna
 Niue
WPRO Palliative Care Systems
Bibliography
 http://www.who.int/cancer/palliative/definition/en/
 http://www.who.int/cancer/media/FINAL
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Palliative%20Care%20Module.pdf
http://www.cancer.gov/cancertopics/factsheet/support/pa
lliative-care
http://en.wikipedia.org/wiki/Palliative_care
http://www.getpalliativecare.org/whatis
http://www.nlm.nih.gov/medlineplus/palliativecare.html
http://www.nhpco.org/i4a/pages/index.cfm?pageid=5953
http://www.liebertonline.com/doi/abs/10.1089/jpm.200
5.8.1127