งานนำเสนอเรื่อง: "Palliative treatment: From cure to care"— ใบสำเนางานนำเสนอ:
1Palliative treatment: From cure to care ศ.พญ.อรพรรณ ทองแตงรศ.พญ.พงศ์ภารดี เจาฑะเกษตรินอ.พญ.จารุวรรณ เอกวัลลภผศ.นพ.รุ่งนิรันดร์ ประดิษฐสุวรรณ
2What is palliative care ? Palliative care is the care of patients with active, progressive, far-advanced disease and a short life expectancy, for whom the focus of care is the relief and prevention of suffering and the quality of life.International Association for Hospice and Palliative Care
3What is palliative care ? Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with 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.WHO, 2002
4Palliative careProvides relief from pain and other distressing symptomsAffirms life and regards dying as a normal processIntends neither to hasten nor postpone deathIntegrates the psychological and spiritual aspects of careOffers a support system to help patients live as actively as possible until deathWHO, 2002
5Palliative careOffers a support system to help the family cope during the patient’s illness and in their own bereavementUses a team approach to address the needs of patients and their families, including bereavement counseling, if indicatedWill enhance the quality of life, and may also positively influence the course of the illnessIs 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.WHO, 2002
6Palliative care: types of cases Traditionally, patients withadvanced cancerend stage organ failures like intractable heart failure, renal failure, liver failure, respiratory failure andlate stage neurodegenerative diseases like motor neuron disease, Parkinson’s disase, dementia.More recently, included patients who isdying from acute illnesses and no longer responding to active treatment e.g. in ICU.
10What is wrong with end-of life care What is wrong with end-of life care ? Opinions of bereaved family members9% of decedents received CPR, 11% ventilator support, and 24% intensive care during their last month of lifeA discussion of treatment decision could not be recalled in 23% of casesMore care to relieve pain or other symptoms was indicated in 18% of deathsFamily members’ recommendations to improve end of life care emphasized better communication (44%), greater access to physicians’ time (17%), and better pain management (10%)Hanson LC, et al. J Am Geriatr Soc 1997 ; 45 :Hanson LC, et al. J Am Geriatr Soc 1997 ; 45 :
11Family perspectives on end-of-life care Over three quarters (78%) believed that there was not enough contact with the patients' physicianshalf reported insufficient information in regard to what to expect from the dying processOver half of the respondents believed that there was not enough emotional support for patientsOne fifth believed that pain or shortness of breath was inadequately treatedTeno JM, Clarridge BR, Casey V, et al. JAMA. 2004;291:88-93
12Quality end-of-life care: Patient’s perspectives Qualitative study using in-depth, open-ended, face-to-face interviews126 participants (dialysis, HIV, NH residents)5 domains of quality end-of-life care:Receiving adequate pain and symptom managementAvoiding inappropriate prolongation of dyingAchieving a sense of controlRelieving burdenStrengthening relationships with loved onesSinger PA, Martin DK, Kelner M. JAMA 1999 ; 281 : 163-8
13In search of a good death: Observations of patients, families, and providers Qualitative study using focus group and in-depth interviews12 focus groups, 6-8 participants each6 major components of good death:Pain and symptom managementClear decision makingPreparation for deathCompletionContributing to othersAffirmation of the whole personSteinhauser KE, et al. Ann Intern Med 2000 ; 132 :
14Good death In general, according with patients’ and families’ wishes Free from avoidable distress and suffering for patients, families, caregiversIn general, according with patients’ and families’ wishesReasonable consistent with clinical, culture, and ethical standardsInstitute of Medicine 1997
15Principles of good death To know when death is coming, and to understand what can be expectedTo be able to retain control of what happensTo be afforded dignity and privacyTo have control over pain relief and other symptom controlTo have choice and control over where death occursTo have access to information and expertise of whatever kind is necessarySmith R. Br Med J 2000; 320:
16Principles of good death (cont.) To have access to any spiritual or emotional support requiredTo have access to hospice care in any locationTo have control over who is present and who shares the endTo be able to issue advance directives which ensure wishes are respectedTo have time to say goodbye, and control over other aspects of timingTo be able to leave when it is time to go, and not to have life prolonged pointlesslySmith R. Br Med J 2000; 320:
24Take home messageThe message of palliative care is that whatever the disease, however advanced it is, whatever treatment have already been given, there is always something which can be done to improve the quality of the life remaining to the patient.