Palliative care – an overview
1. What do patients want at the end of life
- Adequate pain and symptom control
- Avoid futile prolonging of the dying process
- Obtain a sense of control
- Strengthen bonds with loved ones
- Minimize inconvenience for nearest and dearest
- It is about patients with a short life expectancy and have life threatening
diseases
2. Palliative tree
- Treats the whole person
- Promotes quality of life
o Quality of life = broad concept in medicine
How can we obtain it?
How to care for the whole person
- Supports the family
- Is an extra layer of support for all
There is a shortness in professionals => problem!!
Most people want to die at home
Shared decision making
Grief support for family => important!!
3. What is palliative care
- Palliative care aims to relieve suffering + improves the quality of living and
dying
Strives to help the individual and family
- Palliative care is more than end of live care
- In general focuses on improving the overall quality of life for people facing
serious/life-threatening illness, not on curing the cause of the illness
4. Palliative care team
- Support of the patient, relatives, physicians, care team
- Experts in managing complex physical and emotional symptoms
- Support in resolving questions and conflicts between
patient/family/caregivers
- Goals of care, DNR orders and treatment requests or refusals
- Coordination of care across settings
- Time for meetings and counselling
1
, 5. Quality of life
- When you have a life threatening diseases and you are getting to the end
of your life => QoL
- Often patients have a lot of symptoms => what is comfort?
o You cannot eliminate the symptoms -> make it less
- Quality = we always think about what is the best
- QoL in patients with life threatening diseases is about 2 thins
o Reality where the patient is in -> situation, symptoms, …
o Expectations -> at the end of life and you are very tires ad weak and
you expect that you can go back to how you were => not possible
anymore
- QoL depends on the patient!
- When the reality is low and expectation is high => gap of suffering
EXAMEN!!!
o Gap of suffering: patient cannot do what they like to do like
travelling, walking, …
o We have to try to diminish the gap => patient will suffer less!!
Quality of life gap = QoL gap
- Represents the discrepancy between a patients expectations, hopes and
experiences and their actual evolving reality
- Palliative care reduces this gap by addressing physical, psychosocial and
spiritual needs -> facilitating a response shift + providing early,
multidisciplinary intervention to enhance well-being and symptom
management
6. What should medicine do when it can’t save your life
- Palliative care is a philosophy of care and an organized, highly structured
system for delivering care
- Palliative care expands traditional diseases-models
- Goal => enhancing quality of life for patient and family, optimizing
function, helping with decision-making and providing opportunities for
personal growth
- Can be combined with life-prolonging care/ be the main focus of care
When do we stop treatment? When the patient is dead or earlier? => important
decisions
Palliative care can be integrated in life prolonging care BUT its medical care for
life threatening diseases
6.1 Medical effect vs medical benefit
- The effect of a treatment is its impact on a disease, a pathological
condition, an organ
- GOAL => target a diseases, a pathological condition, or an organ +
attempt to fix it or function better
- Effects don’t always create benefits
- Benefit = the effect of that treatment on the whole person -> has an
impact on long term goals
2
1. What do patients want at the end of life
- Adequate pain and symptom control
- Avoid futile prolonging of the dying process
- Obtain a sense of control
- Strengthen bonds with loved ones
- Minimize inconvenience for nearest and dearest
- It is about patients with a short life expectancy and have life threatening
diseases
2. Palliative tree
- Treats the whole person
- Promotes quality of life
o Quality of life = broad concept in medicine
How can we obtain it?
How to care for the whole person
- Supports the family
- Is an extra layer of support for all
There is a shortness in professionals => problem!!
Most people want to die at home
Shared decision making
Grief support for family => important!!
3. What is palliative care
- Palliative care aims to relieve suffering + improves the quality of living and
dying
Strives to help the individual and family
- Palliative care is more than end of live care
- In general focuses on improving the overall quality of life for people facing
serious/life-threatening illness, not on curing the cause of the illness
4. Palliative care team
- Support of the patient, relatives, physicians, care team
- Experts in managing complex physical and emotional symptoms
- Support in resolving questions and conflicts between
patient/family/caregivers
- Goals of care, DNR orders and treatment requests or refusals
- Coordination of care across settings
- Time for meetings and counselling
1
, 5. Quality of life
- When you have a life threatening diseases and you are getting to the end
of your life => QoL
- Often patients have a lot of symptoms => what is comfort?
o You cannot eliminate the symptoms -> make it less
- Quality = we always think about what is the best
- QoL in patients with life threatening diseases is about 2 thins
o Reality where the patient is in -> situation, symptoms, …
o Expectations -> at the end of life and you are very tires ad weak and
you expect that you can go back to how you were => not possible
anymore
- QoL depends on the patient!
- When the reality is low and expectation is high => gap of suffering
EXAMEN!!!
o Gap of suffering: patient cannot do what they like to do like
travelling, walking, …
o We have to try to diminish the gap => patient will suffer less!!
Quality of life gap = QoL gap
- Represents the discrepancy between a patients expectations, hopes and
experiences and their actual evolving reality
- Palliative care reduces this gap by addressing physical, psychosocial and
spiritual needs -> facilitating a response shift + providing early,
multidisciplinary intervention to enhance well-being and symptom
management
6. What should medicine do when it can’t save your life
- Palliative care is a philosophy of care and an organized, highly structured
system for delivering care
- Palliative care expands traditional diseases-models
- Goal => enhancing quality of life for patient and family, optimizing
function, helping with decision-making and providing opportunities for
personal growth
- Can be combined with life-prolonging care/ be the main focus of care
When do we stop treatment? When the patient is dead or earlier? => important
decisions
Palliative care can be integrated in life prolonging care BUT its medical care for
life threatening diseases
6.1 Medical effect vs medical benefit
- The effect of a treatment is its impact on a disease, a pathological
condition, an organ
- GOAL => target a diseases, a pathological condition, or an organ +
attempt to fix it or function better
- Effects don’t always create benefits
- Benefit = the effect of that treatment on the whole person -> has an
impact on long term goals
2
