TITLE: CAAO : A KANKANAEY CULTURE SENSITIVE AND

SUPPORTIVE ENVIRONMENT SETTING FOR HOSPICE PALLIATIVE

CARE

I.

BACKGROUND OF THE STUDY

Terminal illnesses are diseases that cannot be cured or adequately treated and that is reasonably
expected to result in the death of the patient within a short period of time. This term is more
commonly used for progressive diseases such as cancer or advanced heart disease than
for trauma. In popular use, it indicates a disease that eventually ends the life of the sufferer.
In the Philippines, it is in the culture of every Filipinos to value the importance of life until
meeting the age of death. Different tribes present in our culture are engaged with this activity of
enjoying and treasuring the last minute of life. Kankanaey tribe in the Northern part of the
Luzon Island is one of the best example of an existing tribe in the country who was engaged on
the different practices and beliefs of dying.
Palliative care is given to this terminally ill patient for support, comfort and the disease
symptoms management. It is important for a person to enjoy the rest of his life without thinking
of stressors that aids a person to lose hope and change the lifestyle he was engaged with.

II.

REVIEW OF RELATED LITERATURE

A.

PALLIATIVE CARE

What is palliative care?

Palliative care is care given to improve the quality of life of patients who have a serious or lifethreatening disease, such as cancer. The goal of palliative care is to prevent or treat, as early as
possible, the symptoms and side effects of the disease and its treatment, in addition to the
related psychological, social, and spiritual problems. The goal is not to cure. Palliative care is
also called comfort care, supportive care, and symptom management.

When is palliative care used in cancer care?

Palliative care is given throughout a patients experience with cancer. It should begin at
diagnosis and continue through treatment, follow-up care, and the end of life. Palliative care is
given in addition to cancer treatment. However, when a patient reaches a point at which
treatment to destroy the cancer is no longer warranted, palliative care becomes the total focus of

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B

care. It will continue to be given to alleviate the symptoms and emotional issues of cancer.
Palliative care providers can help ease the transition to end-of-life care.
What issues are addressed in palliative care?
Palliative care can address a broad range of issues, integrating an individuals specific needs
into care. The physical and emotional effects of cancer and its treatment may be very different
from person to person. For example, differences in age, cultural background, or support systems
may result in very different palliative care needs.
Comprehensive palliative care will take the following issues into account for each patient:

Physical. Common physical symptoms include pain, fatigue, loss of appetite, nausea,
vomiting, shortness of breath, and insomnia. Many of these can be relieved with medicines
or by using other methods, such as nutrition therapy, physical therapy, or deep breathing
techniques. Also, chemotherapy, radiation therapy, or surgery may be used to shrink tumor

Emotional and coping. Palliative care specialists can provide resources to help patients
and families deal with the emotions that come with a cancer diagnosis and cancer
treatment. Depression, anxiety, and fear are only a few of the concerns that can be
addressed through palliative care

Practical. Cancer patients may have financial and legal worries, insurance questions,
employment concerns, and concerns about completing advance directives. For many
patients and families, the technical language and specific details of laws and forms are hard
to understand.
Spiritual. With a cancer diagnosis, patients and families often look more deeply for
meaning in their lives. Some find the disease brings them more faith, whereas others
question their faith as they struggle to understand why cancer happened to them. An expert
in palliative care can help people explore their beliefs and values so that they can find a
sense of peace or reach a point of acceptance that is appropriate for their situation.
Palliative care increases comfort by lessening pain, controlling symptoms, and lessening
stress for the patient and family, and should not be delayed when it is indicated. Evidence
shows that end-of-life communication interventions decrease utilization , particularly in the
intensive care unit setting, and that palliative care interventions are effective for improving
patient and caregiver perceptions of care Palliative care is not reserved for patients in endof-life care and can increase quality of life and lengthen the patient's life

http://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-carefact-sheet

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B

B. HOSPICE VS.PALLIATIVE CARE

Hospice care and palliative care are very similar when it comes to the most important issue for
dying people: care. Most people have heard of hospice care and have a general idea of what
services hospice provides. What they dont know or what may become confusing is that hospice
provides palliative care, and that palliative care is both a method of administering comfort
care and increasingly, an administered system of palliative care offered most prevalently by
hospitals. As an adjunct or supplement to some of the more traditional care options, both
hospice and palliative care protocols call for patients to receive a combined approach where
medications, day-to-day care, equipment, bereavement counseling, and symptom treatment are
administered through a single program. Where palliative care programs and hospice care
programs differ greatly is in the care location, timing, payment, and eligibility for services.
Place

Hospice
Hospice programs far outnumber palliative care programs. Generally, once enrolled through a
referral from the primary care physician, a patients hospice care program, which is overseen by
a team of hospice professionals, is administered in the home. Hospice often relies upon the
family caregiver, as well as a visiting hospice nurse. While hospice can provide round-the-clock
care in a nursing home, a specially equipped hospice facility, or, on occasion, in a hospital, this
is not the norm.
Palliative Care
Palliative care teams are made up of doctors, nurses, and other professional medical caregivers,
often at the facility where a patient will first receive treatment. These individuals will
administer or oversee most of the ongoing comfort-care patients receive. While palliative care
can be administered in the home, it is most common to receive palliative care in an institution
such as a hospital, extended care facility, or nursing home that is associated with a palliative
care team.
Timing
Hospice

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B

You must generally be considered to be terminal or within six months of death to be eligible for
most hospice programs or to receive hospice benefits from your insurance.
Palliative Care
There are no time restrictions. Palliative care can be received by patients at any time, at any
stage of illness whether it be terminal or not.
Treatment
Hospice
Most programs concentrate on comfort rather than aggressive disease abatement. By electing to
forego extensive life-prolonging treatment, hospice patients can concentrate on getting the most
out of the time they have left, without some of the negative side-effects that life prolonging
treatments can have. Most hospice patients can achieve a level of comfort that allows them to
concentrate on the emotional and practical issues of dying.
Palliative Care
since there are no time limits on when you can receive palliative care, it acts to fill the gap for
patients who want and need comfort at any stage of any disease, whether terminal or chronic. In
a palliative care program, there is no expectation that life-prolonging therapies will be avoided.
It is important to note, however, that there will be exceptions to the general precepts outlined.
There are some hospice programs that will provide life-prolonging treatments, and there are
some palliative care programs that concentrate mostly on end-of-life care. Consult your
physician or care-administrator for the best service for you.

http://www.caregiverslibrary.org/caregivers-resources/grp-end-of-life-issues/hsgrphospice/hospice-vs-palliative-care-article.aspx

C. HUMAN RESOURCES FOR TREATING NEW CANCER CASES IN

PHILIPPINES
The population of Philippines is approximately 90.35 million (45.51 million men and 44.84
million women) and the estimated number of new cancer cases in Philippines for the year 2008,
based on Glob can data for Philippines as a whole was 77184 (36409 in men and 40775 in
women) The five most common cancers in Philippines are breast, lung, gynecological cervix
uteri, corpus uteri and ovary, liver and head and neck (lip and oral cavity, nasopharynx, other
pharynx, larynx and thyroid.

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B

Newly diagnosed cancer patients need pathology, surgery, and chemotherapy and or radiation
therapy. The number of oncologists needed is based, therefore, on the number of patients
requiring pathology, surgery, chemotherapy and radiation therapy this number is estimated from
the percentage of patients requiring surgery, chemotherapy and/or radiation therapy for the top
ten cancers in both men and women. For developing countries the International Atomic Energy
Agency (IAEA) recommends training radiation/clinical oncologists who can prescribe both
radiation and chemotherapy for the common solid cancers, instead of separate medical and
radiation oncologists. Hematological malignancies are treated primarily by hematologistoncologists. The number of specialists needed is based upon the number of cancer patients but
each city, in order to ensure coverage if one person leaves or goes on vacation, must have at
least 2 surgical oncologists, 2 radiation/clinical oncologists, 2 hematologist oncologists, etc.

A. THE GOD'S OF THE IGOROTS

The Igorots inhibit the mountainous area of the northern Philippines, which is called the
Cordillera. The inhabitants of this region are generally called Igorots and they consist of eight
major sub-tribal groups according to linguistic and cultural traits (Reyes 1987: xi). They engage
in gold mining, slash-and burn farming, and planting vegetables as their primary sources of
living. They are keepers of their own distinct cultural and sub-cultural heritage. The Igorots are
primarily animistic in practice and ancestral worshippers by heritage.
:
The Gods of the Igorot tribe. According W.D Sacla, which is now the present vice governor of
Benguet, there are categories of the gods of the igorots (A) Dios Adi kaila, the god which we
The rituals: (a) Canao is a highlight of religious celebration. It is offered for various purposes:
to celebrate as a religious and as part of funeral rite and to secure healing . In some part of
Cordillera, Canao is also celebrated to be blessed by the anitos or Kabunyan. According to
Encarnation, the Canao fulfill two social functions; it brings prestige to the family, it also
affirms and strengthens the existing social structure and the extended family ties. In his survey,
all five leaders fulfilled the ritual requirements by offering thirteen native pigs with white and
black nails. This prestige celebration begins with three pigs, then second rituals require five,
then seven and so on. The Canao plays a vital role in reaffirming the existing order and status
which has been determined in the spiritual world. It is also regarded as a means of influencing
the gods and spirits to maintain the existing order. In addition, the Igorots believe that fame,
material blessings, and good health are granted by Kabunyan and the Ancestral spirits.
Therefore, it is natural for them to view present wealth as reward for their religious piety
expressed through many canao sacrifices; todays canao ensure tomorrows blessing.
Their concept of healing.
Healing is one of the prominent in the Igorots life. According to Mrs. Sabong, when a part of
the family sick, normally they did not go to the doctor but seek counsel of the munbunong.
Mansip-ok, who is gifted in discernment? This mansip-ok analyzees the information about what
the person did, and say at the past, and the mansip-ok tries to determine the cause of the illness
mostly the spirit of the relatives can cause the sickness, the spirit of the relatives need food,

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B

animal, t-shirt, blanket or he is hungry or etc. The mansip-ok also prescribes the cure or specific
animals to be butchered in the ritual for the sick people to be cured.
http://theocultura.blogspot.com/2005/03/gods-of-igorots.html

III.

BACKGROUND PROBLEM

There is no cure or adequate treatment for terminal illnesses. However, some kinds of medical
treatments may be appropriate anyway, such as treatment to reduce pain or ease breathing.
Some terminally ill patients stop all debilitating treatments to reduce unwanted side effects.
Others continue aggressive treatment in the hope of an unexpected success. Usually this people
easily loses hope to continue living and sometimes lead to the use of other illegal actions in
order to cope for this emotional challenges. Kankanaey is an old tribe in the Northern part of
Luzon who are rich in the beliefs and norms of valuing life and death as a process. But regards
to the rich culture the tribe possess, Many does not give importance and neglect the tribe that
may lead to its total community breakdown. The problem is how to incorporate the Culture of
the Kankanaey to the need of having a supportive environment that can be used for palliative
care?
A.

Main Problem

How can a Hospice Palliative Care adapt the Kankanaey culture for a sensitive and supportive
psychosocial environment setting?

B.

IV.

Sub-Problem

How can the design strategies of a psychosocial environment setting be developed and
attained?

How can the design strategies of a cultural-based environment setting be developed and
attained?

How the supportive physical and psychosocial environment setting for palliative care
can be used to the promotion of medical tourism in the country?

RESEARCH GOALS &OBJECTIVES

A.
Goals
.
To be able to develop the design techniques that can provide an environment setting that will
support the psychological and social and physical needs for Hospice Palliative Care.
PROPONENT: RAMOS, MARINELLE S.
DELOS REYES DARYL ANN
BSAR 5B

B.

Objectives

Evaluate the needs for palliative care in the Philippines.

Strategy:
Conduct study for Terminal Illnesses in the country and their statistics and how hospice
palliative care is important in this issue.

Determine the use of palliative and hospice care based on the needs to be able to
formulate new concepts and ideas for implementation.

Strategy:
Study different laws and programs regarding the palliative and hospice care in the
Philippines.

Differentiate Hospice Care and Palliative Care to be able to identify the needs based on
their differentiation.

Strategy:
Evaluate different case studies to be able to identify their differentiation needs.

Study the culture the kan Kanaey has in order to adapt their cultural beliefs of death and
healing.

Strategy:
Gather researches about the culture of kan Kanaey in the Philippines.

V.

RESEARCH TOPICS

A. PSYCHOSOCIALLY SUPPORTIVE DESIGN

The salutogenic approach, as a link and model to a design approach for health promotion,
provides a basic theoretical framework for Psychosocially Supportive Design. It provides a model
and theory to promote health by design. There is a need to systematically investigate and conduct
more empirical studies that verify this model. It is a model that posits that health outcomes are not
only linked to stress reducing factors but are linked to environmental qualities that could measure
the positive effects of health outcomes. Furthermore, this effort requires informed leadership to
guide the organization through the salutary approach process. The issue of psychosocially
supportive design is not only the task of designers; it requires that the entire organization should
understand the meaning of salutary organization. Designers could support the effort by

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B

quantifying the benefit of such an approach. The organization should measure the sense of
coherence; the staff should comprehend it and act on it. We believe that the staff resources to cope
are available (manageability), waiting to be motivated (meaningfulness).
Design qualities that could be included as wellness factors should be identified follow: access
to nature; art; colors; sound of music and nature; lighting; access to pets; use of culture;
familiarity; creating landmarks and references in buildings; aesthetics; harmonious and cheerful
color; social interaction and neighborhoods; spatial composition and articulation; provision of
inviting spaces for social support, all of which seek to engage mentally with positive stimulation
that could strengthen peoples sense of coherence. This approach emphasizes both
psychological and social components that are crucial for health outcomes. In this nascent stage
of scholarship about design and health promotion, the most pressing need is for a better
understanding of the psychological and social components that could link a sense of coherence
to quality of wellness factors within the designed environment. Psychologically Supportive
Design provides the theory, knowledge and models to advance health care design.
B.

A CULTURE SENSITIVE PALLIATIVE CARE

For most clinicians and patients, the discussion of palliative care is a difficult topic. It is
complicated by both the clinician's and patient's belief systems, which are frequently heavily
influenced by cultural and religious upbringing. This article discusses the impact of some of
those differences on attitudes toward end of life decisions. Several different religions and
cultures have been evaluated for their impact on perceptions of palliative care and the authors
will share some examples.
Culture and religion at least partially affect one's perception of palliative care and the decisionmaking that occurs at end-of-life. It is important to realize that there is an entire system at play
that includes the patient, their family, their physicians, and other healthcare providers. In order
to provide the best possible care to patients and families in end-of-life situations, it is important
to understand their cultural constructs as well as their individual preferences. It is also important
for each caregiver to realize that we each bring our own set of biases to these discussions based
on our cultural and religious background and personal experiences.

VI.

BENEFICIARIES
Terminally ill person
Families of terminally ill
Conscious patients with the symptoms of their illness
Persons with medical needs
Kankanaey Tribe.

VII. PROJECT TYPE OF APPLICATION

The Projected Application of this study is focused on supporting the medical, emotional , social
and spiritual well being of terminally ill person through a New Supportive Psychological and
Therapeutic Environment of Hospice Palliative Care Complex .

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B

VIII. INITIAL SITE OPTIONS

The Projected Site can be possible in Manila City, Taguig City and Quezon City.

IX.

BIBLIOGRAPHY

http://scholar.lib.vt.edu/theses/available/etd-07312008110535/unrestricted/VeronicaEstremadoyro_ThesisBook_27August2008.pdf
http://klingmann.tumblr.com/post/815767018/what-is-holistic-sustainability
Space Planning Gretchen Addi, Associate AIA, and Jacqueline Lytle, IIDA, Associate AIA

PROPONENT: RAMOS, MARINELLE S.

DELOS REYES DARYL ANN
BSAR 5B