Family Medicine - Hospice Care and Palliation
Ricardo Sotelo Guanzon, MD March 31, 2017
HOSPICE CARE AND PALLIATION An Introduction
Hospice Care
 Philosophy of care that focuses on the palliation of a chronically
ill, terminally ill or seriously ill patient’s pain and symptoms, and
attending to their emotional and spiritual needs.
 It includes palliative care for the incurably ill given in such
institutions as hospitals or nursing homes, but also care
provided to those who rather spend their last months and days
of life in their own homes.
Palliative Care
 Definition
 History
 Modern Palliative care Approach
 Core Outcomes
 Key Elements
 Forms of Palliative Interventions
 The Bio-Psycho-Socio-Spiritual Approach to care
Palliative Care
 (WHO) The active Total Care of patients whose disease is not
responsive to curative treatment. Control of pain, of other
symptoms, and of psychological, social and spiritual problems is
paramount.
 WHO Updated definition
 “An approach which improves quality of life of patients and their
families fcing life-threatening 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.
Oxford Textbook of Palliative Medicine
 Doyle, Hanks, and MacDonald
 “The study and management of patients with active,
progressive, far-advanced disease for whom the prognosis is
limited and the focus of care is on the quality of life.”
Palliative Care
 Goal: the achievement of the best possible quality of life for
patients and their families.
 Many aspects of palliative care are applicable earlier in the
course of illness, in conjunction with other treatment.
 It affirms life and regards dying as a normal process, neither
hastens nor postpones death, provides relief from pain and
other distressing symptoms,
 integrates the psychological and spiritual aspects of patient
care, offers a support system to help patients live as actively as
possible until death, and offer a support system to help patients
live as actively as possible until death,
 and offers a support system to help the family cope during the
patient’s illness and in their own bereavement.
History
 Middle Ages: Shelters or “hospices” were set up by religious
orders at crossroads leading to religious shrines like Santiago
de Compostela, Chartres, and Rome
 These provided help to pilgrims, who were traveling to the
shrines to pray and seek for miraculous cures of chronic and
fatal illnesses.
 16th-18th Centuries
o Religious orders begin to assist in the care of the sick and
dying in locally or regionally based institution. Most people
die at home, cared for by the women in the family
 1800s
o Madame Garnier establishes a “calvaire” to care for the
dying in Lyon, France. Mother Mary Aikenhead and the
Irish Sisters of Charity open Our Lady’s Hospice in Dublin
in 1879, caring on for the dying.
 Early 1900s
o The Irish Sisters of Charity being to care for the sick and
dying at St. Joseph’s Hospice in East London. St Luke’s
Dr.
Hospice and in the Hospice of God in London open to
serve the destitute and ying
 1935-1990s
o The knowledge base and interest in the psychosocial
aspects of dying and bereavement were advanced by the
works of Worcester, Lindeman, Hinton, Parks, Kubler-
Ross, Raphael, etc
 1960-1970s
o Dr Saunders establishes the St. Christopher’s Hospice in
London in 1967. She emphasized the multi-discipliinary
approach to caring for the dying, the regular use of
opioids to control physical pain,, and alleviating the social,
spiritual, and psychological suffering in patients and
families. New Haven Hospice opens in US
 1980s
o Hospice and palliative care expands throughout Europe
and North America. In US, Medicare adds a hospice
benefit in 1984.
o Care was also offered for people with advanced AIDS.
Hospice and palliative care programs open in East Asia
dn SIngapore
 1990s
o In 1990, the World Health Organization (WHO) convened
an expert committee to spread the message of pain
control and palliative care to an international audience.
o The principle of hospice and palliative care (HPC) become
more understood and accepted.
o More hospice and palliative care centers are established
in US, Canada, Australia, New Zealand, and much of Asia
and the Pacific
 2000 – Present
o HPC specialty training programs are established.
o Palliative Medicine was formally recognized in the United
States as a specialty field in 2006
 Modern Palliative Care Approach
 Core Outcomes
 Key Elements
 Forms of Palliative Intervention
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Palliative Care
 The Solo Specialist Model and the Basic Team Model
 Multidimensional Assessment
 Process of developing a Management Plan
 Process of providing palliative care during sequential
encounters
 Comprehensive Multidimensional Approach
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Quality of Life
 Quality of Life Assessment Instruments
o Measure the current state of the quality of life of the
subject based on several domains
 Other necessary parameters to be evaluated
MAI  1 of 1