Basic Palliative Care for District Hospital Team Palliative

Basic Palliative Care for District Hospital Team Palliative Care Why, When and How ��. ���������������������������

Mortality Rate Heart disease Injuries Cancer AIDS Malaria Tuberculosis Diarrheal disease 67 19 77 19 87 9 1 97 19 1 0 20 9 0 20

���������� ��. 2480 -2573 Thai Health Profile 2010

The Cure - Care Model Palliative/ Hospice Care Life Prolonging Care Disease Progression Disease discovery Curative D E A T H Bereavement care Palliative Care Death Bereavement care Life closure - preparedness Final hours of life care From Frank D. Ferris MD, San Diego; EPEC Course

�������� ? • • • ��������� • ����������������� Advance cancers Advance diseases with poor prognosis: - End-stage heart failure - End-stage lung diseases - End-stage renal failure - End-stage neurological diseases Dementia HIV/AIDS

����� 2. ������� General Indicators ��������������� • Barthel Index: ������� • ������ functional ����� performance status �������������� 50 ������� ����� • �� co-morbidity ��������� morbidity • Functional ��� mortality assessment: Karnofsky, • ������������� PPS, ECOG �� Thomas K, et al. Prognostic Indicator Guidance 4 Ed, Oct 2011. th

��������� Palliative Care Symptom control Disease management Psychosocial and spiritual care

��������� Palliative Care Symptom control Disease management Psychosocial and spiritual care

�������� Pain Dyspnea Constipation Oral symp. Cough Insomnia Delirium N/V Delirium Insomnia Cough Oral symp. 25% 28% 47% 46% 67% Constipation 70% Dyspnea 70% Pain 74% �������� 2555

��������� Palliative Care Symptom control Disease management Psychosocial and spiritual care

Disease Management Treat reversible conditions Symptom management of incurable conditions Palliative surgery: Palliative RT: • Debulking surgery • Immobilize fractures • Bowel obstruction: resection, bypass, stents, ostomy • Spinal decompression & stabilization • • Control of bleeding Relief of obst: SVC, AW Pain control: bone mets Shrinkage of tumor mass: brain metastasis Palliative CMT Manage anxiety, depression Emergency management

��������� Palliative Care Symptom control Disease management Psychosocial and spiritual care

Symptom control: - MO 20 mg/d - Midazolam 1 mg/h at night 0. 5 mg/h day time - Non-pharm Rx of dyspnea Advance care planning Died peacefully 2 months later