Day 1 :
- Palliative Care Research
MB.BS, DPM (UCT), DFM (US), M. Phil (UCT) St. Chads Community Health Clinic Main Road, Ezakheni Ladysmith 3381 South Africa
I was graduated and achieved MB.BS degree in 1989 from the University of Dhaka, Bangladesh. There after I have done three post graduations studies respectively Diploma in Palliative Medicine 2007 and MPhil degree in Palliative Medicine, 2016 From the University of cape town, South Africa. I have also did post graduate Diploma in Family Medicine, 2011 from the University of Stellenbosch, South Africa. I have worked in many countries in the world like Bangladesh, UK, Zambia, Zimbabwe, Botswana and South Africa. Since 2005 I have been working in South Africa under the Department of Health. I am a life member of Royal Medical Society, Edinburgh, UK and Fellow of Royal society of promotion of Health, UK. I am very much passionate about Palliative care Medicine and my thinking is without Palliative care Universal health care coverage cannot be delivered in health sector both public and private.
This research study explores the need for palliative care by the patients who are recovering from stroke after an acute event. Stroke survivors need comprehensive care for their physical, psychosocial, spiritual well-being and additional support. The comprehensive total care in all aspect of physical, social and spiritual well-being can only be offered by the holistic approach of palliative care focusing, as it does, on the rehabilitation for stroke survivors to improve their quality of life.
A literature review was conducted to investigate how palliative care can help to change the quality of life for stroke survivors. There has been little research on the topic of providing palliative care to stroke patients in South Africa. This research study explores the need and understanding of palliative care management for a stroke survival.
This research work is a cross sectional study using mixed methods-both quantitative and qualitative-interviewing patients, and family members of patients, who had suffered from a cerebrovascular accident.
Stroke patients admitted to medical wards, and who had attended the MOPD (Medical Outpatient Department) at Ladysmith Regional Hospital over 4-month period from the month of April to July 2013, and the members from family who were involved in their care at home.
The Islamic University - Gaza, Gaza, Palestine
Dr. Tayseer is a 5th year medical student at faculty of medicine at The Islamic University-Gaza. He is an eager, enthusiastic young researcher. He has authored many important research papers and presented them at national and international conferences. He completed one-year online course with WHO Collaboration Center for Sexual and Reproductive Health with University of North Carolina on Implementation Science. He serves on the Editorial board of many peer-reviewed medical journals. His research interest includes many fields; cardiac diseases especially CVD risk management in diabetic patients, neonatal care, palliative care, rehabilitation and physical medicine, pulmonology and respiratory medicine especially the management of chronic respiratory diseases and neurology. In his spare time, he participates in raising awareness campaigns and helps young students in starting their research projects. His personal interests are reading and playing football.
Background: Individual health is not only determined by the physical wellbeing of us but they are other as important dimension. The spiritual dimension of a patient's life is an important factor that may mediate detrimental impacts on mental health. Spiritual aspects of health-related quality of life among hemodialysis patients, either with chronic kidney disease or end-stage renal failure, have not been fully assessed.
Methods: This was a prospective, cohort, correlation design study of 440 adult patients on maintenance hemodialysis at four centers for hemodialysis in Gaza Strip. Participants were asked to complete a face-to-face interview. The interview contained questions on personal information and four scales. The scales were; FACIT-Sp-12, DASS-21, The Illness Perception Questionnaire (Brief Version) and the quality of life index SF-36.
Findings: Our study involved the interviewing of 440 patients. The hemodialysis patients had, on average, relatively good levels of spiritual well-being, moderate depression, severe anxiety, and mild to moderate stress. The results of the regression models indicated that aspects of spiritual well-being were negatively associated with depression, anxiety, and stress. However, we found that the more comorbidities the patients had, the better spiritually they are. On the other hand, all patients reported low scores regarding their quality of life. Interestingly, some patients believed that their emotional status greatly affected their disease progression. There were no significant differences between male and female patients.
Interpretation: Better spiritual and existential well-being of hemodialysis patients were significantly associated with less depression, anxiety, and stress. It appears that these patients use religious practices and spiritual beliefs as coping mechanisms to overcome their depression, anxiety, and stress. Furthermore, religion and spirituality cannot be separated from other physical complaints particularly in our culture as people in our region tend to be religious by nature.
- Palliative Care Nursing
Senior Manager, Case Management and Program Manager, Patient and Family Education Program at Cleveland Clinic, Abu Dhabi, UAE
Jacqueline Yammine, MN, RN, is the Senior Manager for the Case Management Department and the Program Manager for Patient and Family Education (PFE) Program at Cleveland Clinic Abu Dhabi (CCAD) in the United Arab Emirates (UAE). She has developed a comprehensive post discharge phone call program as part of a new service line in CCAD in collaboration with the PFE, Case Management, Clinical Nurse Coordinators, and the Nurse Triage teams.
Mrs. Yammine was the first case manager joining pre-operational CCAD in August 2014. Between 2005 and 2014, Mrs. Yammine was a Case Manager in a governmental community health services center in the city of Montreal, Quebec, Canada. Between the years 2000-2004, she worked in UAE in Jazzirah and Mafraq Hospital.
Mrs. Yammine is a candidate for the Doctor of Nursing Practice at Case Western Reserve University with an expected graduation date of December 2019. She earned her BSN in 2000 from the American University of Beirut (Beirut, Lebanon) and a MN in 2012 from Athabasca University (Alberta, Canada).
Worldwide, the need for palliative care is rapidly increasing due to an ageing population and increases in life limiting diseases. Palliative care is underdeveloped in most of the world, especially in developing countries in the Middle East and Asia. Although United Arab Emirates (UAE) is an oil-rich country that has the economic potential to provide the state of the art health care to its population, it has underdeveloped palliative care due to minimal provision and integration within the health care system. It is in its infantile phase, hampered by out-of-date laws on resuscitation, misplaced fears over opiate addiction, inadequate palliative care education and training to the medical professionals, lack of supporting policies, unstandardized care practices, and other factors.
Nurses play an integral part in the delivery of palliative care to their patients and families. There are multiple factors influencing the effectiveness of the nurse’s role in the successful delivery of palliative care. Given the context of the cultural background of both the international population of nurses working in the UAE; it is crucial to assess the factors associated with the delivery of palliative care in the population of nurses working in CCAD. Understanding the factors will facilitate planning for appropriate training programs and system changes in palliative care delivery.
Purpose: To perform a pre-implementation data collection to understand nursing knowledge, attitude, subjective norms, and perceived behaviors to help inform a successful implementation plan of palliative care services in a tertiary care hospital in the UAE.
Method: An online questionnaire which captured the nurses’ demographic information, knowledge of palliative care through the Palliative Care Quiz for Nurses (PCQN) survey, the nurses’ attitudes toward caring for terminally ill individuals using the Frommelt Attitude toward Care of the Dying (FATCOD) tool, and other questions to capture the beliefs and behaviours towards palliative care was completed by 214 multinational nurses working in a tertiary care hospital in the UAE.
Results: The vast majority of the studied sample had poor knowledge of palliative care, with the highest PCQN scores for nurses from South East Asia (58.36/100) All nurses (n=214) regardless of the continent of origin had a favourable attitude towards palliative care. Multiple regression tests to follow.
- Palliative Care Services at the End of Life
Bhupal Nobles University, Udaipur, Rajasthan, India.
Suantak D Vaiphei is an independent scholar who is currently working as a PhD research scholar in Department of Psychology at Bhupal Noble’s University, Udaipur, Rajasthan, India. His research area is on “An Assessment On The Effects Of The Biopsychosocial-Spiritual Therapeutic Intervention In Relation To Terminal Illness And Positive Health Outcomes In Indian Palliative End-Of-Life Care.”
Among all the important domains of assessment in palliative end-of-life care effective communication skills is consider to be the most important, as terminal ill experience is mostly preoccupied with several unwanted feelings of mental disharmony and psycho-emotional sufferings. Apart from the physical pain symptom there are several non-pain symptoms that need to be address for the holistic assessment, which require the clinicians working in the palliative end-of-life care to be an active listener to the patient wishes and to act in the best interest of the patients. Nothing is more important than effective communication in building a quality relationship between the patient and the clinicians and to deliver patient’s quality of life through quality decision making policy. However, looking at the present condition of health care system in a developing country like India, effective communication is an unheard topic that has no place even in the curriculum of the undergraduates medical courses. Thus, failing to implement effective communication in its medical practices resulted in patient’s undergoing unwanted medical treatment, which they would opposed if they were asked about their preferences of care in the clinical setting. The absence of effective communication in clinical practices also made the patients to undergo inappropriate treatment that sometime worsen their physical pain symptoms. Effective communication is the mechanism that breaks many barriers between the patient, clinicians and the family. Especially in the face of breaking bad news effective communication plays an important role without hurting the sentiments of the patient and family.
Objective: The purpose of the current study is to identify the essential role of effective communication in end-of-life care and in breaking the bad news. The study is to ponder on the guiding principles of effective communication and how it delivers quality of life in clinical practices for the patient and the family.
Methodology: As palliative end-of-life care is an untouched area of care, the current study will use an analytical review of the collective existing documents and literatures.
- Palliative Care Management
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Dr. Mohammad Hossein Heydari is working in Proteomics Research Center. He has a research interest in palliative care management. He has published papers in various journals.
Introduction: Renal diseases are among the major health problems around the world that cause major changes in patients’ lifestyle and affect their quality of lives. The aim of this study was to evaluate the quality of life of patients with chronic kidney disease (CKD) in Iran through a meta-analysis.
Materials and Methods This study was conducted using authentic Persian and English keywords in the national and international databases including IranMedex, SID, Magiran, IranDoc, Medlib, Science Direct, Pubmed, Scopus, Cochrane, Embase, Web of Science, and Medline. The data were analyzed using meta-analysis (random effects model). Heterogeneity of studies was assessed using I2 index. In this study, SF-36: 36-Item Short Form health-related quality of life (HRQOL), kidney disease quality of life-SF (KDQOL-SF), KDQOL and KDQOL-SFTM questionnaires were used. Data were analyzed using STATA Version 11 software. Results A total of 17200 individuals participated in 45 reviewed studies, and the mean score of CKD patients’ quality of life was estimated by SF-36 (60.31), HRQOL (60.51), and KDQOL-SF (50.37) questionnaires. In addition, meta-regression showed that the mean score of CKD patients’ quality of life did not significantly decrease during the past years.
Conclusion The mean score of quality of life of patients with CKD was lower in different dimensions in comparison with that of normal people. Therefore, interventional measures should be taken to improve the quality of life of these patients in all dimensions.
Dr. Stachura P MBA, University Hospital St. Poelten, Austria
Dr Stachura is an anesthesiologist with an expertise in intensive and palliative care. Points of interest are end of life decision making, management of palliative care, healthcare economics and healthcare research. Dr. Stachura pursued a MBA degree at the University of Bayreuth, Germany. He has also experience in research and teaching at FAU University in Erlangen, Germany and Karl Landsteiner Universtity. Austria.
Statement of the Problem: The presence of palliative Standard Operating Procedures (SOPs) within the network of German Comprehencive Cancer Centers (CCCs) was very heterogeneous. Some CCCs had a group of high quality SOPs, some of them didn´t fulfill quality requierements and some centers didn´t have relevant SOPs at all. In year 2016 was established the coordination office within the CCCs network. One part of the coordination work was to improve the differences in presence and content of palliative care standards. Methodology: 15 CCCs funded by the German Cancer Aid were asked to rate availability and relevance of (1) symptom-related, (2) clinical pathways and (3) measures- and processes-oriented SOPs using a structured questionnaire. After that 15 relevant SOPs were chosen and elaborate within the network according validated template.
Findings: Pain management SOPs were the most common (n =11; 73 %). The most thematic relevance showed SOPs dedicated to pain management, care in the last days of life and delirium and other neuropsychiatric diseases (each n =13; 87 %), followed by bowel obstruction, dyspnoea, nausea and palliative sedation (each n =12; 80 %). All this themes were reflected in SOPs volume edited by coordination office. Conclusion: There was a wide gap between availability and perceived relevance of palliative care SOPs within the network of German CCCs. Due to establishment of coordination office 15 relevant, high quality SOPs were developed. This can contribute to the improvement of patient care. Next research is needed to determine if SOPs have positive effect on palliative care in CCCs.
- Cancer Palliative Care
MBBCH, MSc, MD, Alexandria, Egypt
Many patients are in need for PCC in Egypt as more than 72,000 patients died of cancer in 2012. The estimated increase in number of cancer cases in Egypt is due to changes in the population structure and population growth. “In most of the world, the majority of the cancer patients present with advanced disease. For them, the only realistic treatment option is PAIN RELIEF and PALLIATIVE CARE”.Services of palliative care in Egypt are growing in the last 10years in university hospitals, governmental hospitals under ministry of health and under Nongovernmental organizations (NGOs) in addition to private sector. The role of NGOs is increasing in palliative care and home health care services in egypt and now we have also several ESMO accredited centers containing well established palliative care services. Drug availability & accessibility in Egypt is a big barrier against improving the service, but we have many trials to overcome these barriers. Education in palliative care now in Egypt is improving rapidly for undergraduate and postgraduate and now we have approved professional palliative care diploma as a scientific degree. Government policy is really in need to be reformulated for dealing with opioids and for terminally ill patients in general.
Dr Fan Lihong,M.D., 10th people's Hospital Affiliated to Tongji University,China
Prof. Fan, Chief Physician, Doctoral Supervisor. She has expertise in lung cancer, energy integration medicine research for a long time. She has accumulated rich clinical experience also formed a unique treatment system. She is currently the evaluation Expert of National Natural Science Foundation of China, Evaluation Expert of Shanghai Science and Technology Commission projects, Chairman of Shanghai CDC Committee on Cancer Prevention and Treatment, Director of Institute for the development of Integrative Medicine, Director of Energy Medicine and Health research Institute of Shanghai Jiao Tong University, Director of Energy Metabolism and Health research Institute of Tongji University, Vice Chairman of healthy lifestyle council of Sino-Russian friendship, peace and development committee under the Ministry of Foreign Affairs, and Director of healthy lifestyle research center. Won the "Chinese Medical Science and Technology Award", "China Hospital Science and Technology Innovation Award", China "Wuzhou Women's Science and Technology" Award, and Shanghai "Medical Technology" Award.
Overall survival (OS) of lung cancer varies greatly with individual patients in the global setting. Multiple factors may affect the prognosis. Different antibiotics have significant effects on the prognosis of lung cancer patients. The intestinal microbiome, nutritional status and inflammatory factors all have significant impact on OS of lung cancer patients.The main mechanisms are as follows.1.Immunomodulatory effects of intestinal lung axis microecology on NSCLC.2. Prognostic mechanisms of antibiotic therapy for advanced NSCLC.3.The value of biomarkers in predicting survival of advanced NSCLC patients4. Albumin-bound paclitaxel has a favorable effect on advanced NSCLC and improves the quality of life5.Advanced NSCLC patients with metabolic disease have a worse prognosis.
Dr Gaurav Kumar MBBS,MD ESMO Fellowship Palliative Care Consultant, Palliative Care Tata Medical Center, Kolkata-700156 West Bengal, India
Nausea, vomiting and related symptoms can occur as a direct result of malignancy or as a result of its treatment. These symptoms can be very distressing to the patient and may also have significant physiological consequences. In addition, cancer patients may frequently also develop marked anorexia and become extremely cachectic.
Retrospective analysis of the use of Olanzapine in controlling Nausea and Vomitting in advanced cancer patients
In this retrospective study, 50 patients who presented to OPD with chief complaints of Nausea and vomiting and who were prescribed olanzapine were identified. They were stratified into type of cancer, functional status, duration since last chemotherapy received.
The primary end point was taken as the overall rate of patients achieving a complete response (defined as no episode of emesis and no use of any other rescue anti-emetic medications) and the secondary end point was safety and tolerability of olanzapine with respect to any adverse drug reaction with a causal relationship to olanzapine.
Of the 50 patients who were prescribed Olanzapine 76.5% were female while 23.5% were male. Majority of the patients were in the age group of more than 60 years. Majority of the patients had primarily GI malignancies. 61.7% of patients achieved the primary end point of achieving a complete response with an average time to CR ranging between 2 -10 days.There were no major safety concerns with respect to use of olanzapine.
Use of olanzapine proved to be a beneficial intervention in controlling nausea and vomiting in advanced cancer patients. This pilot retrospective study provides a futuristic pathway of conducting a prospective study on the usage of olanzapine in treatment of nausea and vomiting in cancer patients.
Keywords: Nausea, vomiting, olanzapine
- Palliative Care
Family medicine Assistant Consultant, MNGHA, PHC, Alhassa, KSA
Dr. Maream Alhobel currently works as an assistant consultant in the primary health care clinics in ministry of national guard health affairs “NGHA”, Al-Hassa, Kingdom of Saudi Arabia. NGHA Primary Healthcare Centers are working on providing the best precautionary and therapeutic services to the national guards and their dependents It also serves as a training center for Saudi board family medicine residency program. She earned her medical degree from Imam Abdulrahman bin Faisal University (Formerly known as University of Dammam) school of medicine, Dammam, KSA, and completed a family medicine residency program in King Abdulaziz National Guard Hospital Al-Hassa, KSA. She also earned Arab Board of Family medicine. During her residency, she had an elective rotation in Palliative medicine at King Fahad Specialist Hospital in Dammam and she continues to pursue her interest in Palliative medicine and planning to choose palliative medicine as fellowship.
Saint Joseph University, Beirut, Lebanon
Mouhawej Marie Claire is working in Hôtel-Dieu de France Hospital. He has a research interest in palliative care. He gained his knowledge in the Saint Joseph University, Beirut, Lebanon & inspired many young researchers through her interests.
Palliative care (PC) has been defined by the World Health Organisation (WHO) as ‘an approach that improves the quality of life of patients and their families facing the problems associated with life-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’.
Palliative care is a relatively new discipline in Lebanon although progress has been made in recent years. On 2004, The Ministry of Public Health introduced palliative care as a patient right in an article of the Law on “patients’ rights and informed consent” and established on 2011 a National Palliative Care Committee, with the mandate of elaborating national plans for research, education, practice and policy related to palliative care. This Committee launched on October 2012 the national strategies and plans to raise public awareness: introduction of a Primary Palliative Care curriculum into medical and nursing schools and primary care residency programs to ensure that all primary care physicians can provide a basic level of palliative care to the community; recognition of PC as a new specialty; incorporation the standards for Essential Palliative Care into the new hospital accreditation criteria to ensure that all hospitals in Lebanon are providing a minimum level of palliative care to their patients; introduction of new narcotic drugs to the market and facilitating the procedure to renew them.
Many hospitals have already special pain clinic and some of them introduced recently a consultant PC team (mobile team) but only 2 has PC unit. In our hospital, we launched PC services with an interdisciplinary team 3 years ago, then prepared for a PC unit with adequate local and equipments.
Attitudes and approaches to PC vary widely amongst religions and cultures. Decisions are influenced by the beliefs of the caregivers, patients and their families. Several studies stressed the importance of cultural issues when practicing PC. Concepts such as decision making, life support and advance directives, family involvement in the care, suffering and expression of pain, as well as religion and faith differ from one culture to another, and play important roles in how end-of-life care is perceived.
We describe cultural aspects of PC in our country and discuss, based on our clinical experience, the attitudes and practice of physicians and nurses in PC and challenges to implementing PC in emerging countries.
Dr. Natalia Carafizi, MD, MPH, Foundation"Hospice Angelus Moldova", Republic of Moldova
Statement of the Problem: Palliative care is a new field that was successfully implemented in many countries of the world, but in some states it still remains neglected by the national healthcare systems. In Moldova palliative care was initiated by the non-governmental organisations in 2000. It was introduced into the National Healthcare structure in 2008. Methodology & Theoretical Orientation: The purpose of this study is to assess the role of the Foundation “Hospice Angelus Moldova” in regards of the provided services for incurable patients, basing on the review of the annual reports of the Foundation. Findings: The Foundation “Hospice Angelus Moldova” is a leading provider of domiciliary palliative care services for incurable patients situated in the capital of the country. It was started in November 2001 with the mobile palliative care service for incurable cancer and non-cancer adult patients. In November 2008 the home based pediatric palliative care service for incurable cancer children was initiated, and later, in October 2011 the domiciliary palliative care service for incurable non-cancer children was launched. In December 2013 home-based palliative care service for incurable HIV/AIDS patients was established. In November 2017 the hospice with beds for incurable children was set up. There are also two additional palliative care services: for women, who underwent surgical interventions due to the breast cancer and ostomy patients. Conclusion & Significance: Among the other local state and NGO organisations that provide palliative care services, the Foundation “Hospice Angelus Moldova” still remains the only provider of qualitative palliative care services for different categories of incurable patients in the country.
Cancer diagnosis always changes family psychodynamics either for better or for worse. Within families there is a conflict between the wish to confine and to receive emotional and practical support on the one hand and the wish to protect loved ones from distress on the other hand (particularly children or frail parents).
Almost all cancer patients want to know their diagnosis and most want to be informed about the chance they will be cured. Many patients who have been denied this knowledge have difficulty in understanding why they are becoming weaker and are then relieved and grateful to be told the truth. Patients may be angry with the family who have known about the illness all along and have not thought it right to tell them.
Discussing information with patients at an appropriate time in the illness is important, considering that not all patients want all details about their diagnosis and prognosis.
A conspiracy of silence – collusion – is a source of tension between patients, relatives and health care professionals.It blocks discussion of the future and preparation for parting .If it is not resolved , the bereaved often experience much regret .
Collusion When dose it occurs?
Collusion occurs when patients hesitate to bring up difficult topics and their physicians do not ask them specifically “a don’t ask .. don’t tell situation” patients assume if something is important then the doctor will mention it, doctors assume if patients want to know they will ask
- Hospice Palliative Care
Dr Amberly Burger, MD, MMM Beacon Health System, Indiana, USA
For most clinicians in the United States, Palliative Care means hospice. As such, most procedure subspecialties have not referred to this service. A shift occurred when hospitals became financially responsible for readmissions. A common cause of readmissions to acute care settings is the diagnosis of heart failure which cost hospitals several thousand dollars each readmission. These patients suffer from systemic symptoms such as depression, anxiety, insomnia, and dyspnea, etc. Palliative care interventions have been shown to improve these symptoms and the quality of life for these patients while discussing with the patient their goals. Currently, Cardiology Guidelines encourage the use of a palliative care team to support patients’ and their families who suffer from severe heart failure and its effects. In some cases, this intervention decreases readmissions to the acute care. As hospitals have increased interest in readmission and mortality data, there will be a shift to increasing the need for Primary Palliative Care and Specialty Palliative Care. This presentation focuses on interventions for patients with CHF to improve their quality of life.