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7/31/2019 Challenges for Care at Home_Dr Lim Zee Nee Revised
1/16
Challenges for Care at
Home
Dr Lim Zee Nee MBChB(UK) MRCP(UK)
Palliative Care Physician, HospisMalaysia
10th Malaysian Hospice Congress
2ndJune 2012 Johor
7/31/2019 Challenges for Care at Home_Dr Lim Zee Nee Revised
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Aims
Introduction
Palliative home care and its challenges
Case Study
Approaches to improve palliative care at home
Conclusion
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Home
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In the 19th century
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Introduction
Most of the last year of life is spent at home
50-75% of people express wish to be cared for at home when
they become terminally ill
Percentage of home deaths vary
i. Singapore : 30.3%
ii. Genoa, Italy : 33% ( to 60.8% if referred to palliative home
care)
iii. United Kingdom : 26.5%
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What is Palliative Home Care ?
Applying the principles and philosophy of palliative care in a
patients home
WHO Definition:
Palliative care is an approach that improves the quality of life of
patients and their families facing the problem associated withlife-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.
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Who provides Palliative Care at
Home ? United Kingdom:
General practitioners + district nurses (main providers)
Community palliative care teams support
Malaysia:
Non-Governmental Organizations (NGOs)
hospice organizations (main providers)
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Challenges in providing
Palliative Care at Home -1 Lack of professional experience and expertise
Lack of education and training in palliative medicine
Lack of multidisciplinary teams
Communication and transfer of information
Disease trajectory
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Challenges in providing
Palliative Care at Home - 2 Out of hours coverage
Logistics
Lack of social support, caregiver support, equipment
Access to drugs
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Challenges in providing
Palliative Care at Home - 3 Putting cancer pain management regimens into practice at home
(Schumacher KL et al 2002):
1. Difficulty in obtaining prescribed medications
2. Difficulty in managing side effects
3. Difficulty in managing multiple symptoms simultaneously
4. Difficulty in coping with and understanding complex information
5. Difficulty accessing information
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Challenges in providing
Palliative Care at Home - 4 Ethical issues encountered:
1. Confidentiality
2. Conspiracy of silence
3. Withholding or withdrawal of treatment
4. Treating the family rather than the patient
5. Justice
6. Professional issues
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Case study
Mr W, battled with pancreatic cancer for 6 months prior to
referral to community palliative care
Advanced cancer with multiple lymphadenopathies,
subcutaneous tissue deposits and bone metastases with
recent pathological fracture of the left upper tibia
h ll
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Approaches to Better Palliative
Home Care The Gold
Standards Framework It is a system to improve and optimize the organization and
quality of palliative care for patients in the last 6-12 months of
life
3 central processes: Identify, Assess, Plan
h ll
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Approaches to Better Palliative
Home Care The Gold
Standards Framework 7 Gold Standards of Community Palliative Care
1. Communication
2. Coordination3. Control of symptoms
4. Continuity of care
5. Continued learning
6. Carer support7. Care of the dying
http://www.goldstandardsframework.org.uk/
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Conclusion
Provision of palliative care at home is an essential component
of palliative medicine
We need to identify the barriers and work towards
overcoming the challenges affecting our community in order
to achieve good end of life care at home Non-governmental organizations should work together with
the primary health care to improve our current system of
palliative home care in Malaysia
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