Palliative Care

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Palliative Care

• Dr Christopher Farnham St Johns Hospice and UCH

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Pain in Palliative Care

• What is Palliative Care
• Who delivers it
• How do I get it?
• A Case
• Summary
• Questions

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What is 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 patient's illness and in their own
  bereavement
• uses a team approach to address the needs of
  patients and their families, including
  bereavement counselling, if indicated
• will enhance quality of life, and may also
  positively influence the course of an 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"
• Source World Health Organization (WHO)
  definition of palliative care 2002

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How do I get it?

• Anyone can refer
• Usually via Health Care worker
• No charge
• Continuity
• Seen at home/hospital

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Who provides it?

• Jan 2005
• Adult Inpatient units 220(29 NHS)
• Children 33
• Beds 3156
• Admissions 58,000
• Length of stay 13
• Deaths 30,000
• 18 of all cancer deaths

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Community

• 361 teams
• 155,000 patients
• 70 of all cancer deaths
• 38,000 deaths at home

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Day Care

• 263 units
• 15 people a day
• 8,600 a week
• 32,000 per annum

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Demographics

• 95 Cancer
• 96 White
• 32 lt65
• London 17 units 6 NHS
• Children 12 beds
• 29 Home care teams
• 10 Hospice_at_Home teams

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St Johns

• 19 bedded inpatient unit

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• Charity
• 35 NHS funded
• Cancer
• HIV
• Non malignant diseases

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Care?

• Inpatient
• Respite
• Terminal care
• Symptom control
• Day Centre
• Community Team
• Hospice at Home
• Social Work

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• Physiotherapy
• Lymphoedema
• Befriending
• Bereavement

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Mrs JF

• Recently diagnosed with metastatic breast cancer
• Recent operation
• Struggling at home
• Referred by community nurse

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• Home visit
• Not eating vomiting
• Weak
• Sleeping on sofa
• Alone
• Pain

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So.

• Admitted to Hospice that afternoon
• Pain pump started
• Referred to social work
• Community palliative care nurse organised
• CT head done in hospice
• IV antibiotics
• Referred back to Oncologists and home!

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Summary

• Not all doom and gloom!
• Good holistic care
• Given where you need it

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Questions..