Introduction to Palliative Care 1

8/12/2019 Introduction to Palliative Care 1

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HOSPICE -

PALLIATIVE CARE


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PalliativeLatin wordpallium,meaning a cloak or cover.

Oxford English Dictionary

defines palliative as to relieve

without curing


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ACCORDING TO WORLD

HEALTH ORGANIZATION,

PALLIATIVECARE: Provides relief from pain and otherdistressing symptoms

Affirms life and regards dying as anormal process

Intends neither to hasten nor to

postpone death


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Integrates the

psychological and spiritualaspects of patient care

Offers a support system tohelp patients live as

actively as possible until

death


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Offers a support system to help the

family cope during the patients illnessand in their own bereavement

Uses a team approach to address the

needs of patients and their families,

including bereavement counseling, if

indicated


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Will enhance quality of life andmay also positively influence thecourse of illness

Is applicable early in the courseof illness in conjunction withother therapies that are

intended to prolong life


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chaplains,

social workers,

psychologists,

and other allied health

professionals


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This multidisciplinary

approach allows the palliative

care team to address physical,emotional and social

concerns that arise with

advanced illness.


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HISTORYOFHOSPICEAND

PALLIATIVECARE

Hospice is a philosophy of caring that respects

and values the dignity and worth of each person

and good hospice care is the practical expressionof that personal and professional commitment.


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Hospices are for people approaching death, but

hospices cherish and emphasize life, by helping

patients (and those who love and care for them)to live each day to the fullest.


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MIDDLEAGES

Religious orders establish hospices at key

crossroads on the way to religious shrines likeSantiago de Compostela, Chartes and Rome.

These shelters helped pilgrims, many of whom

were traveling to these shrines seeking

miraculous cure of chronic and fatal illnesses.


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Many died in these shelters while on their

pilgrimages.

During the Crusades, hospices were established

in many places in Europe and the near East to

care for the wounded and sick.


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16TH18TH CENTURIES

Religious orders offer care of the sick and dying

in locally or regionally based institutions. Most

people died at home, cared for by the women inthe family.


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1800S

Madame Garnier of Lyon, France opens a

calvaire to care for the dying. In 1879 Mother

Mary Aikenhead of the Irish Sisters of Charityopens Our Ladys Hospice in Dublin caring only

for the dying.

Madame Garnier of LyonMary Aikenhead


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By the late 19th century the increase in

municipal or charitably-financed infirmaries,

almshouses and hospitals, and the expansion ofmedical knowledge, begins the process of

medicalizing dying. By the mid-20th century,

almost 80% of people die in a hospital or nursing

home.


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1905

The Irish Sisters of Charity open St. Josephs

Hospice in East London, to care for the sick and

the dying.


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EARLY1900S

In London, St. Lukes Hospice and the Hospice of

God open to serve the destitute dying.


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1935

Interest grows in the psychosocial aspects of

dying and bereavement, sparked by the work of

Worcester, Bowlby, Lindemann, Hinton, Kuber-Ross, Raphael, Worden and others.


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1957 - 1967

Cicely Saunders, a young physician previously trained as a

nurse and a social worker, works at St. Josephs Hospice,

studying pain control in advanced cancer. Here Dr. Saunders

pioneered in the regular use of opioid analgesics given by the

clock instead of waiting for the pain to return before giving

drugs. This is now standard practice in good hospice and

palliative care.


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1967

Dr. Saunders opens St. Christophers Hospice in

London, emphasizing the multi-disciplinary

approach to caring for the dying, the regular useof opioids to control physical pain, and careful

attention to social, spiritual and psychological

suffering to patients and families.


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1968

Many hospice and palliative care programs open

in Great Britain in the years following, adapting

the St. Christophers model to meet local needs,offering in-patient and home care.


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1974

The first hospices in Canada opened at the St

Boniface General Hospital in November 1974

under the direction of David Skelton, followed ashort time later at the Royal Victoria Hospital in

Montreal.


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New Haven Hospice (now Connecticut Hospice)

begins hospice home care in the United States,

caring for people with cancer, AIDS and otherfatal illnesses.


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1975 - 1978

Hospices and Palliative care units are opened

across North America. These include hospices in

California, the palliative care unit at the RoyalVictoria in Montreal, the support team at

St.Lukes in New York City, and Church Hospice in

Baltimore.


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1980STOPRESENT

Hospice care, usually emphasizing home care,

expands throughout the United States and

Canada. In the United States, Medicare adds ahospice benefit in 1984. Hospices began to care

for people with advanced AIDS.


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Almost 3000 hospices and palliative care

programs serve the United States. There are well

established hospices and palliative care in

Canada, Australia, New Zealand, and much of

Asia and Western Europe. Hospices and palliativecare is now available in over 40 countries

worldwide, including many less-developed

Nations.


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The World Heath Organization sets standards for

palliative care and pain control, calling it a

priority. But studies show that most patientsstill receive little or no effective palliative care,

and pain is often very poorly controlled, primarily

due to lack of medical knowledge, to unfounded

fears of addiction, and (in less developed

nations) to shortage of opioids.


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The principles of good hospice and palliative care

are understood and accepted and all patients

who choose to accept hospice palliative care canbe assured of competent and compassionate

care in their home, in nursing homes, hospitals

and hospices.


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INTERNATIONALISSUES

Opioid availability

Restricted access to suitable

cancer treatment facilities

Open, sensitivecommunication


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Documents

Introduction to Palliative Care 1