Hospice and Palliative CareDr. Hadi Awad HmoudMB.Ch.B, FICMS-S, MRCS-Ireland, LMCC-Canada

Facts. Why we need Hospice or palliative

care. What palliative care means Obstacles for palliative care. Hospice Approach Which on is superior to other

Objectives

FACTS Death is inevitable, it is rather a normal

process.

Death does not always mean staff failure.

Sometimes we unnecessarily waist our resources to prolong life.

Most patients fear not from death itself, but from the way of their death.

Patient wants to die in peace NOT in pieces.

Care must be offered for dying patient and caregiver too.

Rationale Questions1-Are we meeting our dying patients’ and caregivers’ demands, like Good Death (comfortable and suffering free), Truth Telling, Good Quality of Life, Good place for death.2-Are we trained or willing to do so?3-Are we equipped with tools of doing so?4-Are these demands unreachable?

The Nature of Suffering and the Goals of Medicine The relief of suffering and the cure of disease

must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians’ failure to understand the nature of suffering can result in medical intervention that , not only fails to relieve suffering but becomes a source of suffering itself.

Cassell, Eric NEJM 1982;306:639-45.

Symptoms at the End of Life: Cancer vs. Other Causes of Death

Cancer OthersPain 84% 67%Trouble breathing 47% 49% Nausea and vomiting51% 27%Sleeplessness 51% 36%Confusion 33% 38%Depression 38% 36%Loss of appetite 71% 38%Constipation 47% 32%Bedsores 28% 14%Incontinence 37% 33%

Seale and Cartwright, 1994

Is it bleak future?

There is an answer, but not well established yet!!

Hospice versus Palliative care

Cure vs. Palliation

Cure:Hope is eradication of disease. Cure costs sacrifices. Palliation: Hope is comfort.Any intervention that relieves

suffering is acceptable

How could we assess the patient’s needs?Physical.

Psychological.

Spiritual.

Social.

OLD MODEL OF CARE

CURATIVE

PROLONGATION OF LIFE

DIAGNOSIS

PALLIATIVE

RELIEF OF SUFFERING

DD

Predominantly curative

DEATH

Curative Treatment(Cancer, CHF, COPD, AIDS,

Dementia debilitating Neurological diseases …)

Palliative Treatment

Bereavement CareHospice

DeathDiagnosis

Most Recent MODEL OF CARE

New aspects

Palliative care is specialized medical care forpeople with end-stage illnesses. It focuses on relieving suffering and improving quality of life, regardless of the diagnosis. It strives to focus on both the

patient and the family (Caregivers). It is provided by a multidisciplinary

team of doctors, nurses, and other specialists to provide efficient support.

It helps patients and their families innavigating the healthcare system. It offers guidance for difficult andcomplex treatment choices. It provides emotional and spiritualsupport for patients and their families

Our accompleshment!!Indeed we barely made it touchable

NOT Reachable

Obstacles for palliative careDelay of the decision making .Costs. Social and cultural issues.Shortage of facilities.

Continue Opiate especially Morphine restriction:

morphine is not readily available across the country. It is recommended to be given frequently and extended to a long period.

ContinueLack of trust between staff and

family.

Patient and family education including other caregivers.

Education and training of palliative care for medical staff, particularly physicians and nurses is not available.

Why we need Palliation or

Hospice??

Year NO of new cases register Male NO % Female NO % Registered cases per 100,000 Population

1991 5720 3125 54.63 2595 45.37 31.05

1992 8526 4735 55.54 3791 44.46 44.99

1993 8471 4632 54.68 3839 45.32 43.49

1994 7785 4230 54.34 3555 45.66 38.91

1995 7947 4344 54.66 3604 45.34 44.69

1996 8360 4466 53.42 3894 46.58 45.69

1997 8592 4521 52.62 4071 47.38 45.67

1998 9033 4774 52.85 4259 47.15 45.74

1999 8936 4556 50.98 4380 49.02 43.95

2000 10,888 5376 49.38 5512 50.63 52.00

001 13,332 6758 50.69 5674 49.31 61.38

002 13,985 6964 49.80 7021 50.20 62.97

003 11,248 5698 50.66 5550 49.34 49.17

004 14,520 7525 51.83 6995 48.17 61.63

005 15,172 7505 49.47 7667 50.53 54.26

006 15,226 7377 48.45 7849 51.54 52.84

007 14,213 6656 46.83 7557 53.16 47.88

008 14,180 6589 46.47 7591 53.53 44.46

Total 196,135 99,831 50.90 96,304 49.10 -

Rate of malignancies and Gender distribution in Iraq

Blue: Surveyed, Red: Officially registered

Rate and type of malignancies in Basra in 2008

Good Palliation IndicatorMorphine consumption can be used as an

approximate measure of pain control and hence success of this form of palliative care.

Developing countries consumed only 6% of global consumption of morphine. (almost 80 percent of the world's population)

10 countries together accounted for 87% of total world consumption of morphine.

International Observatory on End of Life Care

Average daily consumption of defined daily doses (for statistical purposes) of morphine per million inhabitants, 2000-2002

Source: International Narcotics Control Board Narcotic Drugs: Estimated World Requirements for 2004. Statistics for 2002. New York: United Nations, 2004.A limited range

Morphine Consumption

Hospice Is specialized care for patients whohave been given a terminal diagnosis with a grief prognosis. Offers care for the whole person,focusing on pain and symptommanagement, psychological, social,and spiritual care. Hospice seeks to relieve suffering while focusing on dignity and quality of life.

It is a support to patients andfamily members throughout the dyingProcess. It offers bereavement follow up forprimary caregivers and family members. It is an appropriate opportunity forpatients to meet those who shared them the sufferings It is done in purposeful foundedPlace(ACCOMODATION).

Which one does work better for IraqPersonaly I believe that Hospice is superior to Palliation for these reasons:1-It minimizes the Cost on family.2-It is suitable for our low educated society.3-It mininmizes the burden of relentless seek for cure.4-Cost-effective for the budget and resources.

Elderly Palliative care, the right to quality of lifeElderly Palliative care, the right to quality of life

Fear of way Of Death

God May Bless You All

Thank You