IMAI and palliative care

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IMAI and palliative care

• Julia Downing Sandy Gove
• F. Akiiki Bitalabeho

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WHO definition of Palliative Care

• Palliative care is an approach that
• improves the quality of life of patients and
  families facing the problem of 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, pyscho-social and
  spiritual.
• 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, or antiretroviral/OI therapy
  and includes those investigations needed to
  better understand and manage distressing clinical
  complications
• (Sepulveda et al, JPSM Nov 2002)

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• Palliative care for children
• Palliative care for children is the active total
  care of the childs body, mind and spirit, and
  also involves giving support to the family.
• (WHO 2002)

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IMAI and Palliative Care
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IMAI approach and palliative care

• The first IMAI tools to be field-tested were for
  palliative care in 2003.
• Important part of HIV/AIDS care even with advent
  of ART
• Public health approach to home-based palliative
  care
• capable of achieving wide coverage using locally
  adapted simplified, standardized, integrated
  tools.
• used in many different countries e.g. Uganda,
  Namibia, Kenya, Ethiopia

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IMAI approach to palliative care- core
materials

• Palliative Care Guidelines for first-level
  facility health workers for clinical management
  and back-up to home-based care 2 day clinical
  training course for nurses
• Caregiver Education Booklet to prepare families
  and community-based carers to provide effective
  home care
• Second level learning programme - under
  development for doctors and clinical officers
• Country adaptation is being used in many
  countries and adapted to situation

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IMAI and Palliative Care Training

• The training
• - skills health workers
• - educates caregivers
• - supports patients
• to form an effective partnership between the
  HCW, the caregiver and the patient as members of
  an integrated health team, providing high quality
  care at the health facility and at home.
• Innovative training methodology- involving PLHIV
  as Patient- Expert Trainers.
• PC training targets all health cadres therefore
  supporting and enabling task shifting e.g. Nurse
  prescribing
• Development of skills is key

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Current Palliative Care IMAI work

• Review of primary care guideline module and
  update re caregivers
• PC section of second level learning programme
• Review and finalise for printing training
  materials
• Review adaptation guide section on PC
• Input into IMAI pre-service training module

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Other palliative care activities

• Competencies for PC
• Provide outline for short course in paediatric
  palliative care
• Developing protocol re validation of nurse
  prescribing

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Challenges re IMAI and Palliative Care

• Palliative care module and training an orphan.
• Lack of understanding of palliative care, its
  importance and the public health approach
• Drug availability used more for advocacy

• Follow up after training to consolidate
  knowledge and skills learnt.
• Quality assurance
• Harnessing the skills of Expert Patients.

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Lessons Learnt and Recommendations

• Adequate palliative care for comprehensive HIV
  care.
• Integrated at all service levels.
• All health worker cadres trained.
• Need follow up and mentorship - Clinical mentors
  need to be thoroughly prepared to support symptom
  management and end of life care.
• Need pre-service as well as in-service training

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in all that we do lets not lose site of what
really matters.
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Thank you