Chapter 4

Palliative Care (2)

Weiwei Liu (Vivian)
Public Health and Management
Department

Objectives

What is palliative care?

Challenges
How can palliative care help?
Hospice Care
five stages of psychological changes of
the dying patients

1. What is Palliative Care?

Palliative care seeks:
to prevent or relieve physical, social,
emotional and spiritual suffering produced by a
life threatening medical condition or its treatment
to help patients with such conditions and their
families live as normally as possible
to provide them with timely and accurate
information and support in decision making

Palliative Care

Identification,
impeccable
assessment &
treatment of
symptoms

Goals of Palliative Care

1. to provide relief from pain and other physical
symptoms
2. to maximize the quality of life
3. to provide psychosocial and spiritual care
4. to provide support to help the family during the
patients illness and bereavement

Palliative Care
IS
Evidence based medical
treatment
Vigorous care of pain
and symptoms through
illness
Care that patients may
want at the same time as
treatment to cure or
prolong life

NOT
giving up
accelerating death
the same as hospice
care

Ethics of Euthanasia & Natural

Death Difference of Euthanasia and Natural Death
Euthanasia

Natural Death

Motivation

Relief patients pain

Relief patients pain

Method

killing

Palliative care could

improve the quality of
life

Patients
state

Despair, destroy
themselves

Cherish the end of

life period

Religion

Be against

Naturally, all in
favor

Medical
Ethics

Against to no harm"
principle

In accordance with the

do no harm
principle

Relatives
feeling

Regret due to kill

the patient

The patient received

good care, relative
without regret when
the patient die

Palliative Care
Palliative
Medicine

Hospice

Palliative Care Model

Old- Abrupt transition to hospice
D
I
A
G
N
O
S
I
S

Disease
Modifying
Therapy
Prolongation of life

Palliative
Therapy
Relief of
Suffering

D
E
A
T
H

Palliative Care Model

Optimal- Continuum of care
Disease
Modifying
Therapy
Palliative Therapy

Presentation
Acute

Illness
Chronic

End of
Life Care Death Bereavement

Who Needs Palliative

Care?
People of all ages with lifethreatening or debilitating illness
Children with congenital injuries or
conditions
Persons with severe trauma
People living with progressive chronic
illness

2. Challenges
Patient

Not legally competent

Lacks verbal skills to describe
needs, feelings, etc.
Not achieved a "full and complete
life

Family

Difficulty understanding treatment

plans, prognosis, etc.
Needs relief from burden of care
Stress on finances

Challenges
Caregivers
sense of failure
lack familiarity with
dosages and
medications for
symptom management
lack experience in
caring for dying patients

3. How Can Palliative Care Help

Symptom Management
Hospital Care
Home Care
Psychosocial Support
Bereavement

How is Palliative Care Different from

Curative Care? (
)
Curative Care
(=disease-oriented, restorative)

Palliative Care
(=supportive, person-oriented)
Diagnosis

Dying
Person with Illness
Family
Caregivers

DISEASE PROGRESSION

Be
re
av
em
en

Death
Support services for
families and caregivers

4.

Palliative Care

VS. Hospice

Care
Should start at the time of diagnosis

Provided in the last six months of life

Occurs simultaneously with aggressive

or curative treatments, often managing
symptoms that these therapies cause

Usually cannot be given at the same as

curative or aggressive treatments such as
chemotherapy, radiation therapy

Often underfunded and difficult to

access in many areas

Paid for in full by the Medicare benefit

and by Medicaid (in most states)

Most often done in the hospital

setting; More community-based
outpatient palliative care services are
beginning to pop up in larger
metropolitan areas but access is still
limited; Nowadays moving into homecare

Most often provides care in a patients

home setting, could be at their own
home or that of a relative, a nursing home
or assisted living facility, or retirement
community; Some hospices offer
inpatient services in dedicated hospice
facilities

5. five stages of psychological

changes of the dying patients
1 shock and denial
2 anger
3 bargaining
4 depression
5 acceptance

Anger
Why
me

Bargaining

acceptance

Im ready
for death.

yeap, its
me,
but

Gradually understand the

Health

true consequences

Stable diease

The loneliness,
inner guilt

Diagnosis
with a
terminal
illness

Denial
Its
impossible
You make a
mistake

More self-sustaining
growth

depression
Yes, its me.

The psychological
process of dying
patients.

Summary
The focus of palliative care is the
comfort and well being of the
patient and family.

Thank you!