INTRODUCTION TO PALLIATIVE CARE

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INTRODUCTION TO PALLIATIVE CARE

• Alison Humphrey
• Clinical Nurse Specialist in Palliative Care, STH

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AIMS

• To explore development of Palliative Care
• Definitions
• Where are we now
• Service available and how to access them

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HISTORY OF HOSPICE/PALLIATIVE CARE
PALLIATIVE CARE
SUPPORTIVE CARE
END OF LIFE CARE
MODERN HOSPICE CARE Influenced by Ciceley
Saunders Separation 1945-1965 Transition
1965-1985 Incorporation 1985 - present
HISTORY OF HOSPICE Existed in Roman Times
Charitable institutions for travellers 19th
century religious influence and opened for care
of the dying
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PALLIATIVE CARE
PALLIATIVE CARE
SUPPORTIVE CARE
END OF LIFE CARE
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PALLIATIVE CARE

• Palliative care is an approach that improves the
  quality of life of patients and their families
  facing the problems associated with
  life-threatening illness, through prevention and
  relief of suffering by means of early
  identification and impeccable assessment and
  treatment of pain and other problems physical,
  psychosocial and spiritual (WHO, 2002)
• Palliative Care should involve holistic care
  according to NICE (2004) striving for best
  quality of life, applicable earlier in the
  course of the illness in conjunction with other
  treatments and to help patients to live as
  actively as possible until death and to help the
  family to cope during the patients illness and
  in their own bereavement (p.20).

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SUPPORTIVE CARE

• The emphasis of supportive care is to support
  patients and families during treatment and
  allowing them to live as well as possible with
  the effects of the disease (NICE, 2004 p.18) and
  even mentions from diagnosis through to cure as
  well as to death and bereavement.
• This would fit with the cancer survivorship,
  initiative (DOH, 2007a, 2010) a cancer survivor
  being someone who has completed initial
  treatment and has no apparent evidence of active
  disease, or is living with progressive disease
  and may be receiving treatment but is not in the
  terminal phase of illness, or someone who has had
  cancer in the past (Corner, 2007).
• Long Term Conditions

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END OF LIFE CARE

• End of Life Care Strategy (2008) has the aim of
  allowing patients to live as well until they die
  throughout the last phase of life and into
  bereavement.
• The last phase considered to be last 12 months of
  life.
• Advanced Care Planning
• Amber Bundles

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EMPHASIS ON END OF LIFE CARE

• One in 10 patients die during their hospital stay
• Chris Smyth The Times Published 19 March
  2014
• Liverpool care pathway review shows challenges in
  palliative care Melanie Henwood Guardian
  Professional, Tuesday 23 July 2013 
• Neuberger Report, 2013
• Francis Report, 2013

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GENERAL PALLIATIVE CARE

• General palliative care is the level of
  palliative care which should be provided by all
  healthcare professionals, in primary or secondary
  care, within their duties to patients with
  life-limiting disease

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SPECIALIST PALLIATIVE CARE

• Holistic and multidisciplinary approach
• MDT consist of Doctors, Nurses, Social Worker,
  Therapists, Chaplain, Complementary Therapies
• Provided at the expert level, by a trained,
  multi-professional team in order to manage
  persisting, sever or complex problems

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REFERRAL CRITERIA
UUncontrolled Complex Symptoms
Complex Social Issues
End of Life care
Psychospiritual Issues
Psychological Emotional Issues Related to illness
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REFERRALS NOT MEETING CRITERIA
Condition inactive and stable
Respite
Chronic Pain
Palliative Package of care
Long term care
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SERVICES AVAILABLE IN STH

• Hospital Support Team consisting of Consultant,
  Registrar and Clinical Nurse Specialists
• Macmillan Palliative Care Unit 18 bedded
  inpatient unit
• Outpatient clinics run by Consultants and
  Registrars
• Community Visits
• Complex Case Management

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COMMUNITY TEAM SERVICES IN SHEFFIELD

• Community Specialist Palliative Care Team
  consisting mainly of Clinical Nurse Specialists
  with access to Consultant and Registrar Support
• St Lukes Hospice Inpatient Centre 20 bedded
  unit
• Therapies and Rehabilitation Centre Day Care

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OUT OF HOURS

• Community Contact St Lukes main switchboard.
• STH Palliative Care CNS Team providing seven day,
  9-5 service
• STH after 5pm Contact switchboard who will
  contact Registrar on call for Palliative Care

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HOW TO REFER
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REFERRAL FORM
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REFERRAL FORM
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HOW REFERRAL IS PROCESSED FOR COMMUNITY SERVICES
AND INPATIENT UNIT
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REFERRAL TO HOSPITAL SUPPORT TEAM

• Referrals reviewed by Palliative Care CNS
• Referrals prioritised
• Visit ward

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REFERENCES

• CORNER, Jessica (2007) Making the National Cancer
  Survivorship Initiative a Reality powerpoint
  presentation at Britain against Cancer Conference
  London http//www.macmillan.org.uk/Documents/GetIn
  volved/Campaigns/Campaigns/APPG/brita accessed
• DEPARTMENT OF HEALTH, MACMILLAN CANCER SUPORT AND
  NHS IMPROVEMENT (2010) National Cancer
  Survivorship Initiative (NCSI) Vision. London,
  Crown
• DEPARTMENT OF HEALTH (2008) End of Life Care
  Strategy - Promoting high quality care for all
  adults at the end of life. London, Crown
• DEPARTMENT OF HEALTH (2013) MORE CARE,LESS
  PATHWAY A REVIEW OF THE LIVERPOOL CARE PATHWAY
• NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE (2004)
  Improving Supportive and Palliative Care for
  Adults with Cancer London, National Institute for
  Clinical Excellence
• Report of the Mid Staffordshire NHS Foundation
  Trust Public Inquiry www.midstaffspublicinquiry.co
  m
• The AMBER Care Bundle Design Team (2011)
  www.ambercarebundle.org
• WORLD HEALTH ORGANISATION (2002) WHO Definition
  of Palliative Care http//www.who.int/cancer/palli
  ative/definition/en/