Concept and Philosophy of

Palliative care
Prof.dr. W.Suardana Sp.THT-KL(K)
Chairman of Indonesia Palliative Society Bali Region
Past President of Indonesia Palliative Society

INTRODUCTION
Palliative care is increasingly recognized
as an important component of quality
care for cancer patients
care for those patients who are near the
end of life is an essential aspect of
cancer care

INTRODUCTION
Palliative care is an interdisciplinary team
approach to care, with a focus on comfort
and quality of life rather than prolongation
of life or "cure" for a patient and their loved
ones.
the past 10 years have seen impressive
growth in palliative care research,

What is palliative care

Palliative care is any form of medical care or
treatment that concentrates on reducing the
severity of disease symptoms, rather than
providing a cure.
The goal is to prevent and relieve suffering and
to improve quality of life for people facing
serious, complex illness

WHO
Palliative care improves the quality of life of
patients and families who face lifethreatening illness, by providing pain and
symptom relief, spiritual and psychosocial
support to from diagnosis to the end of life
and bereavement
The World Health Organization (WHO)
defines palliative care as "the active total
care of patients whose disease is not
responsive to curative treatment

HISTORY
Palliative care began in the hospice movement and is
now widely used outside of traditional hospice care
In the 19th century a religious order established
hospices for the dying in Ireland and London
The modern hospice is a relatively recent concept
that originated and gained momentum in the United
Kingdom in 1967.
It was founded by Dame Cicely Saunders, widely
regarded as the founder of the modern hospice
movement.

HISTORY
The first United States hospital-based palliative
care programs began in the late 1980s at a
handful of institutions such as the Cleveland
Clinic and Medical College of Wisconsin

Terminology
Palliative care should start
at the time of diagnosis.
Palliative care occurs
simultaneously with
aggressive or curative
treatments, often
managing symptoms that
these therapies cause.
Palliative care is often
underfunded and difficult
to access in many areas.
Palliative care is most
often done in the hospital
setting.

Hospice care is appropriate

during the last 6 months of life.
Hospice care usually cannot be
given at the same as curative
or aggressive treatments
Most insurances also cover
hospice services in full or with
minimal co-pays.
Hospice care most often
provides care in a patient's
home setting, or assisted
living facility, or retirement
community.

Concept and philosophy of Palliative

care
provides relief from pain and other distressing
symptoms;
affirms life and regards dying as a normal process;
intends neither to hasten or postpone death;
integrates the psychological and spiritual aspects of
patient care;
offers a support system to help patients live as
actively as possible until death;
offers a support system to help the family cope during
the patients illness and in their own bereavement;

Concept and philosophy of Palliative

care
uses a team approach to address the needs of
patients and their families, including
bereavement counseling, if indicated;
will enhance quality of life, and may also
positively influence the course of illness;
is applicable early in the course of illness, in
conjunction with other therapies that are
intended to prolong life, such as chemotherapy
or radiation therapy, and includes those
investigations needed to better understand and
manage distressing clinical complications.

Components and Principles of

Palliative Care

Attitude to Care
Communication
The Care
Coping with stress

Woodruff R,1996

Attitude to Care
caring attitude
Commitment
consideration of Individuality
cultural considerations
Consent
choice of site of care

Communication
Communication amongst health care
professionals
communication with patient and
family

The Care
clinical context
comprehensive and multidisciplinary
care excellence
Consistent
co-ordinated
Continuity
crisis prevention
caregiver support
Continued reassessment

Coping with stress

Managing of emotional distress
Reject from illness
Angry
Bargaining condition
Depression
Surrender

Traditional or past view of palliative care

Treatment of the underlying disease

Active treatment of medical problems

Diagnosis of
disease

Palliative
care

death

A modern view of palliative care

Diagnosis of disease

death

Treatment of disease
Surgical/radiation/chemotherapy

Active medical treatment

Hypercalcaemia,fractures,bowel obstruction,etc
Symptomatic and supportive palliative care
Pain;other physical problems,psycho-socio-cultural-spiritual

Robert Twycross,1995

Diagnosis

Death

Specific anticancer treatment

Palliative Care

New concept of Palliative care

Bereavement
support

Goals
Relief from suffering, treatment of pain
and other distressing symptoms,
psychological and spiritual care, a support
system to help the individual live as
actively as possible, and a support system
to sustain the individual's family.
Holistic patient care: Bio-psychosocio- cultural and spiritual

Bio/Physical-suffering
Relief from pain pain is the most common
complain of cancer patient
Nausea and vomiting
Problem of nutrition
Infection
Problem from organ to suffering by cancer or
metastasis
Problem of urination and bowel habit
etc

Psychological suffering

Reject from illness

Angry
Bargaining condition
Depression
Surrender

Social suffering
With her/his illness or disease cannot
active in the community
Economic problem

Suffering
Pain
+other physical symptoms
+psychological problems
+social difficulties
+cultural issues
+spiritual concerns

Total suffering

Care
Treatment of pain
&other physical symptoms
&psychological problem
&social difficulties
&cultural issues
&spiritual concerns

Total care

Cancer patient-Total suffering

Quality of Life

Cultural
Spiritual
Psychological
Pain

r
a
C
l
ta
o
T

Total suffering

Social

Physical symptoms

Whole person
care
Physical good
Mental good
Cultural and
spiritual good

holistic care

Medical good

TOTAL GOOD

Intrinsic and
extrinsic aim
of the
palliative care

Multidiscipline approach in palliative care

Medical staff

Nursing staff

Social worker

physiotherapist

Palliative care

psikiater

nutritionists
psychologist

Priest

Family

volunteer

Palliative care in dying patient

Room for dying patients

COMPASSION

PAIN MANAGEMENT

LEARNING TASK

Aunt Tilly is diagnosed with breast cancer and is

recommended to start chemotherapy and radiation
treatments. Aunt Tilly knows that chemotherapy can make her
feel horrible and radiation can be painful. She is referred to a
palliative care program for symptom management and
receives excellent treatment of her chemotherapy induced
nausea, fatigue, and oral thrush (a yeast infection of the
mouth common in chemotherapy patients). She is also visited
by a Medical Social Worker who helps her complete her
advance directives, just in case she loses the ability to speak
for herself. She gets weekly visits from a chaplain who prays
with her and discusses Aunt Tilly's theological questions.

LEARNING TASK
Well, Aunt Tilly endured three rounds of chemotherapy and
a week of radiation but her breast cancer is aggressive
and resistant to treatment. Aunt Tilly is told that she has six
months to live and is referred to hospice care. Hospice
comes to Aunt Tilly's home and continues with the expert
symptom management that the palliative care team
started. They address new symptoms as the arise and
begin to talk to Aunt Tilly about her impending death and
what her goals and priorities are. Hospice helps Aunt Tilly
to fulfill her life-long dream of riding in a Porsche and helps
her reconcile with her long estranged daughter Talula.
Aunt Tilly dies peacefully surrounded by her family.

LEARNING TASK
1. Describe the disease suffered aunt Tilly!
2. What is recommended by doctor to treat aunt
Tilly?
3. Describe the effect of treatment which is
recommended by doctor!
4. Aunt Tilly knows that chemotherapy can make her
feel horrible and radiation can be painful.
Discussed of this effect of treatment knows by aunt
Tilly!
5. Discussed of yeast infection of the mouth very
common in chemotherapy patients!

LEARNING TASK
6. Describe what Palliative team will do to aunt Tilly
whos suffered of late stage of cancer disease!
What objective of the strategies!
7. Discuss why aunt Tilly need hospice care!
8. What will the Hospice team take care for aunt
Tilly condition?
9. Discussed the different between palliative care
and hospice care!
10.Aunt Tilly dies peacefully surrounded by her
family. Discussed of this statement!

Cancer Pain
Pain from the tumor
Most cancer pain arises when a tumor presses on bone,
nerves or body organs. The pain may vary according to
location.
Pain related to cancer therapy
-Cancer treatment -- including chemotherapy, radiotherapy
and surgery -- also can cause pain.
-Post-operative or post-op pain is acute (short-term) pain
suffered as a result of surgery.
Other painful conditions
Pain that has nothing to do with your illness or its
treatment, such as: headaches, muscle strains and other
aches and pains.

Pain assessment

The main tools used are:

Verbal Descriptor Scale (VDS),
Numeric Rating Scale (NRS) and
Visual Analog Scale (VAS).

Pain assessment

Management of pain

WHO Three Step