Palliative Care Overview And Concepts. Mike Harlos MD, CCFP, FCFP Professor and Section Head, Palliative Medicine, University of Manitoba Medical Director, WRHA Palliative Care Medical Director, Pediatric Symptom Management Service. What Is Palliative Care?. Surprisingly difficult to define
Mike Harlos MD, CCFP, FCFP
Professor and Section Head, Palliative Medicine, University of Manitoba
Medical Director, WRHA Palliative Care
Medical Director, Pediatric Symptom Management Service
Any illness, any age, any location…
(a personal definition)
Palliative Care is an approach to care which focuses on comfort and quality of life for those affected by life-limiting/life-threatening illness. Its goal is much more than comfort in dying; palliative care is about living, through meticulous attention to control of pain and other symptoms, supporting emotional, spiritual, and cultural needs, and maximizing functional status.
The spectrum of investigations and interventions consistent with a palliative approach is guided by the goals of patient and family, and by accepted standards of health care.
Jonathan – 6 yr old boy terminally ill boy
Ref: “Armfuls of Time”; Barbara Sourkes
Palliative Care… The “What If…?” Tour Guides
Can Help Inform The Choice Of Not Intervening
A SOBERING TRENDLINE
Lifetime Risk of Dying (%)
Lifetime Risk of:
Heart disease: 1:2 men; 1:3 women (age 40+)
Cancer: > 1:3
Alzheimer's: 1:2.5 – 1:5 by age 85
Don’t confuse “Palliative Care” – the philosophy of approach to care in the context of life-limiting illness with “Palliative Care service delivery”….
Palliative Care As A Philosophy Of Care
EVOLVING MODEL OF PALLIATIVE CARE
Palliative Care services should be challenged to broaden their involvement to address the needs of those affected by sudden, unanticipated end-of-life circumstances:
On Such a Fundamentally Sad Issue?
have high expectations for death?
Expect – if not demand…
What About A “Death Plan”… with broader expectations than the usual clinical issues in a Health Care Directive?
Ref: Bruera 1992 “Why Do We Care?” Conference; Memorial Sloan-Kettering
Wolfe J. et al, NEJM 2000; 342(5) p 326-333
(% Of Affected
Nausea And Vomiting
Alleviate Suffering for a Condition Which:
Stds of practice for symptom management, availability, responsiveness, communication
Improving Palliative Care