1. Palliative care
medicine
Presented by
Palliative care team, PSOC
08-Feb-2023

2. Section 1
Introduction

3. PSOC initiated its services on October-2010
Palliative care medicine is one of the
subspecialities provided by the center

4. ‫شهر‬ ‫في‬ ‫األورام‬ ‫لعالج‬ ‫سلطان‬ ‫األمير‬ ‫بمركز‬ ‫العمل‬ ‫بدء‬ ‫تم‬
‫عام‬ ‫من‬ ‫أكتوبر‬
2010
‫الرعاية‬ ‫قسم‬ ‫منها‬ ،‫الدقيقة‬ ‫التخصصات‬ ‫من‬ ‫عددا‬ ‫المركز‬ ‫يتضمن‬
‫االالم‬ ‫وعالج‬ ‫التلطيفية‬

5. Definition of palliative care
Palliative care is an approach that improves the quality
of life of patients (adults and children) and their
families who are facing problems associated with life-
threatening illness.
The service is mainly provided to advanced cancer
patients and their families.

6. ‫تعريف‬
"
‫التلطيفية‬ ‫الرعاية‬
"
‫للمرضي‬ ‫الحياة‬ ‫جودة‬ ‫تحسين‬ ‫الي‬ ‫التلطيفية‬ ‫الرعاية‬ ‫تخصص‬ ‫يهدف‬
(
‫أطفاال‬
‫وبالغين‬
)
‫الخطيرة‬ ‫األمراض‬ ‫بسبب‬ ‫صحية‬ ‫متاعب‬ ‫من‬ ‫يعانون‬ ‫ممن‬ ‫وأسرهم‬ .
‫وأسرهم‬ ‫المتقدمة‬ ‫األورام‬ ‫لمرضي‬ ‫الخدمة‬ ‫هذه‬ ‫تقدم‬

7. Goals of palliative care service:
- Improve the quality of life of patients with
advanced cancers.
- Control of distressing symptoms, such as
pain, shortness of breath, nausea,
vomiting and constipation.

8. ‫التلطيفية‬ ‫الرعاية‬ ‫أهداف‬
:
-
‫المتقدمة‬ ‫األورام‬ ‫لمرضي‬ ‫الحياة‬ ‫جودة‬ ‫تحسين‬
-
‫السيطرة‬
‫الغثيان‬ ،‫التنفس‬ ‫صعوبة‬ ،‫االالم‬ ‫مثل‬ ‫األعراض‬ ‫علي‬
،
‫النوم‬ ‫واضطرابات‬ ‫القيء‬

9. Our palliative care team provides its services in a
multidisciplinary approach.
Our team includes:
- Palliative care physicians and nurses
- Psychiatrist
- Social worker
- Dietitian
- Health educator
- Physiotherapist
- Spiritual care provider (Sheikh)
- The primary caregiver of the patient
Whenever indicated; the medical care plan is arranged
with other medical and / or surgical subspecialties.

10. ‫طب‬ ‫فريق‬ ‫طريق‬ ‫عن‬ ‫االالم‬ ‫وعالج‬ ‫التلطيفية‬ ‫الرعاية‬ ‫بقسم‬ ‫الطبية‬ ‫الخدمة‬ ‫تقدم‬
‫ي‬
‫متكامل‬
‫علي‬ ‫التلطيفية‬ ‫للرعاية‬ ‫الطبي‬ ‫الفريق‬ ‫يشتمل‬
:
-
‫التلطيفية‬ ‫الرعاية‬ ‫وتمريض‬ ‫أطباء‬ ‫طاقم‬
-
‫النفسي‬ ‫الطبيب‬
-
‫االجتماعي‬ ‫األخصائي‬
-
‫التغذية‬ ‫أخصائي‬
-
‫الطبيعي‬ ‫العالج‬ ‫أخصائي‬
-
‫الدينية‬ ‫الرعاية‬ ‫مقدم‬
(
‫الدينية‬ ‫الشئون‬ ‫قسم‬
)
-
‫المرافق‬
(
‫المرافقون‬
)
‫للمريض‬ ‫األساسي‬
‫الحاجة‬ ‫تقتضي‬ ‫عندما‬ ‫األخري‬ ‫والجراحية‬ ‫الطبية‬ ‫بالتخصصات‬ ‫االستعانة‬ ‫يتم‬

11. Palliative care service is provided to our
patients according to the latest Regional
and International palliative care medicine
guidelines, with emphasis on:
- Respecting patient’s privacy and dignity.
- Providing sympathy with patients and his
primary caregivers.
- Respecting patient’s autonomy.

12. ‫االقليمي‬ ‫التوصيات‬ ‫ألحدث‬ ‫طبقا‬ ‫للمرضي‬ ‫الطبية‬ ‫الخدمة‬ ‫تقدم‬
‫ة‬
‫علي‬ ‫المحافظة‬ ‫مع‬ ‫والعالمية‬
:
-
‫المرضي‬ ‫وكرامة‬ ‫خصوصية‬ ‫احترام‬
-
‫ومرافقيهم‬ ‫المرضي‬ ‫مع‬ ‫النفسي‬ ‫والتعاطف‬ ‫الدعم‬
-
‫المريض‬ ‫قرارات‬ ‫احترام‬

13. The medical care is planned with the patient
and his primary care givers.
Whenever feasible, the medical care is
provided at home.
Patients are then followed regularly at home
by the home care team.
Patients are given scheduled outpatient
clinic appointments.
Patients and their primary care givers are
educated and oriented regarding the
alarming symptoms requiring
hospitalization.

14. ‫المريض‬ ‫مع‬ ‫بالتنسيق‬ ‫المناسبة‬ ‫العالجية‬ ‫الخطة‬ ‫وضع‬ ‫يتم‬
‫والمرافق‬
(
‫المرافقين‬
)
‫له‬ ‫األساسي‬
‫سمحت‬ ‫كلما‬ ‫بالمنزل‬ ‫الطبية‬ ‫الرعاية‬ ‫خدمات‬ ‫كامل‬ ‫تقديم‬ ‫يتم‬
‫الطبية‬ ‫الرعاية‬ ‫فريق‬ ‫ويقوم‬ ،‫بذلك‬ ‫للمريض‬ ‫الطبية‬ ‫الحالة‬
‫للمريض‬ ‫المنتظمة‬ ‫بالزيارات‬ ‫المنزلية‬
‫الخارجية‬ ‫بالعيادات‬ ‫للمتابعة‬ ‫للمريض‬ ‫منتظمة‬ ‫مواعيد‬ ‫تحدد‬
‫والمرافق‬ ‫للمريض‬ ‫الطبية‬ ‫الحالة‬ ‫توضيح‬ ‫يتم‬
(
‫المرافقين‬
)
‫للتنويم‬ ‫المستشفي‬ ‫زيارة‬ ‫دواعي‬ ‫فيها‬ ‫بما‬ ‫له‬ ‫األساسي‬

15. Our palliative care service is provided
through:
- Outpatient palliative care clinics service.
- Inpatient service.
- Daycare service.
- Home care referral service.
- Virtual clinics service.

16. ‫األورام‬ ‫لمرضي‬ ‫االالم‬ ‫وعالج‬ ‫التلطيفية‬ ‫الرعاية‬ ‫خدمة‬ ‫تقدم‬
‫خالل‬ ‫من‬ ‫المتقدمة‬
:
-
‫الخارجية‬ ‫العيادات‬
-
‫بالمستشفي‬ ‫التنويم‬
-
‫األورام‬ ‫لعالج‬ ‫سلطان‬ ‫األمير‬ ‫بمركز‬ ‫الواحد‬ ‫اليوم‬ ‫رعاية‬ ‫خدمة‬
-
‫المنزلية‬ ‫الرعاية‬
-
‫االفتراضية‬ ‫العيادات‬

17. Section 1
Palliative care service

18. Assessment of palliative care patients
1- When to do ?
2- Who will do ?
3- Where to do ?
4- How to do ?

19. 1- When to interfere ?
( Assessment & Management )
1- The old model.
2- The new integrated model.

20. The old model :

21. The new integrated model :

22. 2- Who will assess the palliative
candidate ?
Palliative care team
Physician
Nurse
Dietitian
Social worker
Spiritual care provider (Sheikh)
Psychiatrist

23. 3- Where to assess ?
• Clinic visit.
• Inpatient bed.
• Hospice.
• Home care visits.

24. 4- How to assess the palliative
care patient ?
1- History (Personal, Operative, Medications, chronic
illness)
2- General examination (vital signs, weight, height,
wounds)
3- Local systemic examination (by physician)
4- Palliative assessment :
a - Performance status
b - Symptom assessment
c - Specific precautions
d - Special assessment (nutritional, psychological,..)
e - Phases of palliative care delivery

25. A- Performance status :
1- ECOG PS

26. 2- Karnofsky PS :

27. 3- Palliative performance scale :

28. B- Symptom assessment :
- According to patient’s opinion.
- Done regularly every visit.
- Standardized assessment tool to
assess changes in symptom severity
overtime.

29. ESAS Chart

30. C- Specific precautions :
1. Arm precautions (in breast cancer)
2. Fall precautions (elderly, delirium)
3. Isolation precautions (Neutropenic patients)
4. Stoma care (gastrostomy, tracheotomy,
colostomy)
5. Wound care and repositioning (bed-bound
patients)

31. D- Special considerations :
1- Psychological assessment
(Depression, anxiety, …)
1- Nutritional assessment :
• Manageable causes (Anorexia, nausea or vomiting)
• Potentially curable causes (Dysphagia, ulceration)
• Caloric requirements
• Route of delivery (oral, NGT, gastrostomy, TPN)
• Follow up the progress

32. E- Phases of palliative care delivery:
1- Stable phase
 Minimal symptoms
 Clear management plan
 Regular clinic visits, no or minimal hospital
admissions
 Mainly patient-directed care
 PPS between 100% and 70%

33. 2- Progressive phase
 Distressing increasing symptoms
 Maximum patient suffering
 Patient and caregiver-centered care
 Recession of curative treatment
 Full supportive care
 Frequent hospital admissions
 PPS between 60% and 40%

34. 3- End of life phase
 Patient’s wish for place of care
 Ensure symptom control
 Limited investigations
 Only effective simple medications are used
 Routes of administration are reviewed
 Family meetings to prepare for the expected
clinical outcome
 Social worker support (wills, financial issues,
custody arrangements for children,…)
 Religious support