Scientific Program

Day 1 :

  • Mental Health Palliative Care
Location: 8

Session Introduction

Mrs. Padma Sesha Sarada Lingaraju

Manager of Counselling at Sparsh Hospice

Title: Mental Health in Palliative Care - Quality of Life Issues

Mrs. Padma Sesha Sarada Lingaraju, Telecounsellor, Indian Association of Clinical Psychology, Counselling for mental health during COVID crisis. She earned Certification from Stanford University, 2019 about Palliative Care Always. She also earned Certification in End of Life Care: Challenges and Innovation, University of Glasgow, 2020 and Alzheimer’s Disease and Dementia Care Certification, University System of Maryland, 2020.Member of International Association of Hospice and Palliative Care (IAHPC) and life member of Indian Association of Palliative Care (IAPC).


INTRODUCTION:: Mental well-being of a patient and his/her family determines the path of life for the patient , especially at the juncture of hospice admission.Mental health comprises well-being at all other levels. It affects our behaviour, thoughts and even the outcome.

OBJECTIVES: To ensure mental well-being of the patient and family at the end of life.

MATERIALS AND METHODS: In a country like India, definition of quality of life is so varied that it is quite shocking. People from different walks of life in terms of social stature, religion, culture and financial background ,have a quality of life concept very individualised. While planning for quality of life at hospice, we need to keep in mind their social structure. Sensitising the family beyond the scope of their understanding of mental well-being might disturb their life beyond the comprehension of the health care provider. Mental well-being is about self-esteem, confidence, respect, communication, family bonds,finances and dignity and normalisation of stress factors. Mental well-being can result in better coping with physical and emotional stress of the disease. Mental well-being can be ensured for the patient by keeping him physically comfortable,reducing family collusion,having a definite care plan,addressing his spiritual issues,arranging for family meetings,facilitating rituals, connecting them with support groups,

RESULTS:: Mental well-being results in dignity and quality of life in the last days of the patients. It relieves the family of guilt and sense of wrongdoing.

CONCLUSION:: In EOLC,we address the total pain of the patient like physical, emotional,social and spiritual. Mental well-being is the overall well-being of the patient at the above four levels. This might sound complex but when handled with empathy and open mindedness, it can be achieved both for the patient and the provider.


  • Dementia
Location: 9

Session Introduction

Ms. Virginia Lee


Title: Assessments, Interventions and Caring for Patients with Alzheimer's and Dementia

Virginia Lee has been a Social Worker for the past 25 years. Her work has primarily focused on assisting people who are frailer-ed,. living with chronic illness, in health care social work  She also sees patients who seek help for variety of reasons.  For most of her career, she worked at  Masonicare Care, a premier home care agency, assisted living facilities, and nursing homes and NYC Health and Hospital Corporation at Bellevue Hospital, a trauma hospital and Coler Memorial Hospital.  She has sat on many committees, including Advisory Member of Late Life Issues Committee in Fairfield County, Co Chair Aging Committee with Connecticut National Association of Social Workers, Creative Learning  Advisory Board Meetings. She has a passion for professional training, education, and empowering aging and palliative care. Virginia has been awarded the prestigious Albert Nelson  Marquis Life time Achievement Award. 


In 2016, The World Alzheimer’s report estimated that 47 million around the globe had Dementia.  By 2050, an American will be diagnosing with Alzheimer’s every 33 seconds.  Caregivers provide 18 billion hours of unpaid assistance. In 2017, Every 66 seconds, an American will develop Alzheimer’s Disease. .   Leading cause of Dementias are: Alzheimer’s Disease Vascular Dementia, Parkinson’s Disease, Lewy Body Disease, Alcohol-related Dementia,(Korstkoff’s syndrome), HIV/AIDS Related Dementias, and Frontal-Temporal Dementias ( Pick’s Disease). Early signs of Alzheimer’s over 60 found those who consistently slept for more than 9 hours each might twice as likely to develop neurological conditions.  Arterial stiffness in Older Adults predicts future Dementia (Chen Cui U of Pittsburgh 2018).

Stages of Dementias include Mild Cognitive impairment, Early Dementia, Moderate Dementia, and Severe Dementia.

Risk factors of Dementia and Alzheimer’s include age, sedentary lifestyle, genetics, head trauma, lower education, poor social support, obesity, depression, hypertension, smoking, heart disease, and miscarriage in pregnancy.

Caring for Patients with Alzheimer’s and other Dementias include home safety tips, memory Aids, Enhanced communications, Strategies to assist with patients with mood and behavioral problems, such as Reminiscence techniques, communications enhancement techniques and positive psychology. 

Implications for practice, policy or research.  There’s a positive connection between higher levels of education and lower risk of dementia, including that the higher educated exercise more and both weight  

Researchers and Dr. Tanzi suggest that the therapeutic answer might ultimately be a cocktail of medications. “Drugs to hit amyloid early on, drugs to hit tangles early on, drugs to hit inflammation,” Dr. Tanzi said. “And you might want to add antivirals.” (NYTimes Nov.2018)

Delirium and Alzheimer’s disease share many underlying path physiologic contributions. Thus preventing delirium may in turn prevent Alzheimer’s disease

 Legal Instruments and financial issues to be planned with, Social Workers, Geriatric Care Managers, Alzheimer’s Association and Elder Law Attorneys. 

Finally, the presentation will encourage social workers to examine their own practice implications when working with Alzheimer’s Disease and related dementias in community, , hospital, long term care settings, palliative care and hospice settings. Personal and Professional challenges. Professional and Reading Resources will be provided.


  • Pain and Symptom Management
Location: 10

Session Introduction

Duc Chung, MD

Chief, Hospice and Palliative Medicine VA Central California Healthcare System, USA

Title: Palliative Care Management of Nausea and Vomiting

Dr. Duc Chung is the chief of hospice and palliative care at the VA Central California Health Care System in Fresno, CA and an assistant clinical professor at UCSF Fresno Hospice and Palliative Medicine Fellowship. He also served on the public policy and leadership committees with the American Academy of Hospice and Palliative Medicine (AAHPM) and currently the Chair-Elect of the Rehabilitation Interest Group of AAHPM. He enjoys resident and fellow teaching and mentorship. In his spare time, Dr. Chung enjoys singing and songwriting and often uses his compositions to heal and inspire patients during their difficult life journeys. 




Nausea and vomiting are common symptoms that diminish patients’ overall quality of life in hospice and palliative settings. Approximately 62% of patients endure nausea and vomiting at the end-of-life. These difficult-to-control symptoms require not only a thorough history and physical examination but a broad understanding of the pathophysiology and mechanisms of action of different medications to effectively control nausea and vomiting. Key points in our history include obtaining details about positional vertigo, abdominal pain, early satiety, headaches with early morning nausea, increased CNS tumor burden, and ruling out other causes of nausea and vomiting, including polypharmacy, metabolic derangements, and psychological factors such as anxiety. It is also important to keep in mind that any particular patient can present with nausea and vomiting of multifactorial etiologies. The pathophysiology of nausea and vomiting involve the peripheral, cortical, chemoreceptor trigger zone (CTZ), and vestibular pathways. Within these pathways are mu, dopaminergic, muscarinic, and cannabinoid receptors that signal into the vomiting center, resulting in the nausea and vomiting reflex. For example, the peripheral pathway include mechano and chemoreceptors in the GI tract, serosa, viscera and provide afferents to the vomiting center via the vagas and splanchnic nervous systems, the glossopharyngeal nerve and sympathetics. The cortical pathway involve inputs from the sensory system as well as anxiety. The chemoreceptor trigger zone, located outside of the blood brain barrier, receives afferents from toxic triggers in the bloodstream and CSF which feed into the vomiting center. Blocking these various pathways will provide symptomatic relief. Various medications such as the commonly used Zofran, Compazine, Reglan, Haldol, Phenergan act through blocking various receptors that reduce signal pathways to the vomiting center. Recent evidence also demonstrated potential utility of NK-1 receptor antagonist such as aprepitant in the management of refractory nausea and vomiting. Furthermore, numerous studies have demonstrated potential utility of cannabinoid-containing medications such as dronabinol. The overall premise of nausea and vomiting management center around targeting multiple receptors simultaneously to block signal pathways to the vomiting center, thereby providing symptomatic relief. In summary, this presentation will highlight the pertinent questions that we should address during our history taking with emphasis on the pathophysiology of nausea and vomiting, the various receptors involved, medications employed to target these receptors, and explore novel medical and alternative interventions to target nausea and vomiting. A deep understanding of nausea and vomiting pathways will significantly alleviate much of these distressing symptoms.



  • Palliative Care Research
Location: 1

Session Introduction

Dr. Mohammed Jamil Hossain

MB.BS, DPM (UCT), DFM (US), M. Phil (UCT) St. Chads Community Health Clinic Main Road, Ezakheni Ladysmith 3381 South Africa

Title: To investigate the Need for Palliative care in Cerebrovascular Accident (stroke) patients at Ladysmith Regional Hospital

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.



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
Location: 2

Session Introduction

Ms. Amani Sindi


Title: A Journey Lived: Through the Eyes of a Palliative Care Provider

Amani Sindi, BSN, RN, have a 13 years of cumulative nursing experience in (general surgery, MSICU, BMT, Oncology and palliative care). Since 2016 she has taking the role of palliative clinical Specialist for Oncology Department in King Faisal specialist hospital & Research Center – Jeddah- Kingdom of Saudi Arabia. As Palliative home health care coordinator she Initiated 24/7 hotline assistance and the first palliative data base in collaboration with palliative head section in KFSH&RC. This palliative data base was added in the cancer registry with collaborated with MOH, which has helped in PI projects and research studies. Amani She is a member & speaker in the following programs: Nursing Ethics Sub-Council, Nursing residency transition to practice program, Patient and Family Education Program, a healthcare transformational Change Agent, in the Nursing development & Saudization dept. She's a loving mom who lives' by The Principle of reciprocity in Communication in both her personal and professional life.


Palliative care nursing is an exceptional specialized filed that has persistently care & support patients and families facing a life limiting illness, terminal illness and in end-of-life where the serious illness affects more than just a patient’s body. 
The application of together has shaped up palliative care in a sense what patients & families go through is as heavy as huge rock over someone chest. And together we can delicately help to left up that heaviness as much as possible. It's no one man show, it’s an effort of different professions comes together as one team for one goal “QUALITY OF LIFE TILL THE END"
To care for patient's physical, emotional, psychological, spiritual and social wellbeing, and financially, to support them while making heart-rending decisions and prepare the patients & families for the expected future.
The word HUMAN that drives me to holistically care for my patients &families, knowing that we are "human everything within us connected to each other and each other connected to all" body, mind and soul, all connected, a whole entity.
Every patient deserve to have a DECENT QUALITY OF LIFE, preserved DIGNITY and AUTONOMY. having a PCN helping hand to hold, guide and support throughout the ups and downs of the journey, to address their concerns and needs, give them the hope of comfortable and peaceful life yet having the conversation for what next?! And be able to move forward with no guilt's no regrets. It's AS REWARDING AS IT IS CHALLENGING. 
Layla she's 54 year-old deeply into family bound diagnosed with breast ca in 2016 been through intensive treatment till she's transferred to palliative care 2019 with PPS 30% she has been in the hospital for 3months very depressed and not talking to anyone having an emotional pain till one day she told me I want to be home with all of my family before I die 
I communicate her needs to the team, papered the house for her care, referred her to HHC, educated and trained her primary care giver, sent her home and supported them by having a 24/7hotline available for them in case of emergency 
Pt within a week, her condition changed start eating, talking, laughing and gained weight, more comfortable, coping will with her huge breast wound and pain controlled. When I visited her she said "I wasn’t happy for long time but NOW I'm happy, thank you",
What it takes to make her feel that way was as simple as a tow way heart to heart communication just as Human. 

Jacqueline Yammine

Senior Manager, Case Management and Program Manager, Patient and Family Education Program at Cleveland Clinic, Abu Dhabi, UAE

Title: Factors Related to Palliative Care Implementation among Multinational Nurses in a Tertiary care Hospital the United Arab Emirates

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
Location: 3

Thahir Noorul Isra qualified as a Social Worker in 2013. She has started to worked in Aroh India as coordinator of Community Base Comprehensive Palliative Care project. She started supervising Counselling students on placement when she became a Senior Practitioner in 2015 in Sri Lanka. Isra has initiated a CBCPC unit in the year of 2015 in Colombo-15 at Sri Lanka. In 2016 she has started a V4Us campaigned through the social media to familiarize the word “Palliative Care” among youngster. In 2017 National Cancer Control program invited her to share her experience on practicing palliative care in Muslim community in Sri Lanka. In 2015 Isra became a Rehabilitation Counselor in Rehabilitation of Person property and industry Authority (“REPPIA”). In 2019 Isra joined National Institute of Education as a Assistant Lecturer within the Skills and Inclusive Department. Along with she is carrying palliative care social work practice with her team.



Every patient gets fundamental right to receive good quality of care at the place where he/she lives. Home is a place of memories, familiarity and safety, a place where we remain comfortable, relaxed and confident and the best place for freedom of choice and autonomy. Unfortunately, it has become doubt due to Covid-19 pandemic situation. Unexpected lockdown increase level of stress among not only aged, but also general public (figure-1). Myths and media created anxiety among this vulnerable person. When lockdown period palliative care volunteer or front-line health care providers are not getting permission to express empathy and acknowledge emotions with patients and their families. They also surface level victims of Covid-19.  The palliative care social worker is playing a vital role in Community Base Comprehensive Palliative Care setting. He is a driven energy to the unit. Most of the patient spending their quality of days with the support of CBCPC. Lockdown has closed all doors with all supportive mechanism in Sri Lanka. First week of lockdown palliative care social workers received many calls from the patient and caregivers. It was a huge challenge. No access to the house. Form a help desk for receiving a call to hear them and empower through the empathy. Develop healthy relationship with forces and front-line health care providers to deliver essential services in their door steps. Arrange a facilitator to support when they need to link with palliative care doctors and other health workers. A group of volunteers gets involved to create awareness and educate the patient, family and the general public through the social and other media platform.  This strategy makes them to cope with the specific challengeable situation like Covid-19.


  • Cancer Palliative Care
Location: 5

Session Introduction

Dr Fan Lihong

Dr Fan Lihong,M.D., 10th people's Hospital Affiliated to Tongji University,China

Title: Immunomodulatory effects of intestinal lung axis microecology and other factors on the prognosis of advanced non-small cell lung cancer

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.

  • Palliative Care
Location: 6

Session Introduction

Dr. Maream Alhobel

Family medicine Assistant Consultant, MNGHA, PHC, Alhassa, KSA

Title: Palliative Care: Knowledge and Attitude Among Saudi Residents, 2016

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.


Introduction: Palliative care is a medical specialty, which focuses on relieving the suffering and improving the quality of life for patients who are facing life-threatening illnesses and their families. Looking after dying patients is inseparable from our responsibility as physicians. However, dealing with the dying patients is challenging for the majority of physicians.
Aim: To document the knowledge and attitudes of palliative care among residents from major specialties, Eastern Province, Saudi Arabia. Methodology: A cross-sectional study was carried out using a self-administered questionnaire to a convenient sample of residents from major specialties from various training centers in Eastern Province, Saudi Arabia, during 2015–2016. A total of 433 residents have been participated in the study.
Results: About 46% of the residents showed lack of overall palliative care knowledge, and almost half of them had negative views toward palliative care. Almost 60% of them achieved good score in pain management. The majority of respondents had never received training in palliative medicine (91.7%). It was observed that higher training level has a positive effect on the overall knowledge, including basic concept, pain, and psychiatric symptoms’ management. Also, previous exposure to patients who would benefit from palliative care has a direct effect on overall knowledge and attitude scores.
Conclusion: The results indicate a low level of knowledge and attitude regarding palliative medicine among sampled residents. Also, it highlights the importance of exposing the residents to palliative medicine field to improve their knowledge and attitude.


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.


  • Hospice Palliative Care
Location: 7

Session Introduction

Ms. Christy Roames

Pediatric Palliative Massage Therapist, University of Chicago Comer Children's Hospital, Illinois, USA


Christy Roames is a board-certified massage therapist specializing in hospice and palliative care for adults and pediatrics. Certified through the NCBTMB (The National Certification Board for Therapeutic Massage & Bodywork) with an MT (Massage Therapy Certification) through AMTA, Christy has an expansive history with massage therapy. After receiving a teaching degree from Barat College of DePaul in 1995, she worked as an elementary-level teacher from 1995 through 2000 in Illinois, Oklahoma, and Nevada. From 2000-2006, Christy worked as a co- pastor in Las Vegas, Nevada and went on to homeschool her two children from 2006-2010. Christy then attended Everest College-Chicago from 2011-2012, in an advanced program for Massage Therapy/Therapeutic Massage. Present day, she works in Illinois as a pediatric
palliative massage therapist for the University of Chicago Comer Children’s Hospital, as a hospice massage therapist for Palos Hospital, and as an independent contractor for rehabilitative and therapeutic massage for cancer and Parkinson’s patients. Along with her work in education and massage therapy, Christy has been involved in a variety of volunteer experiences. She was a project leader for Teen Mania Ministries International from 1996-2007 and a Special Olympics coach (out of Lemont High School in Lemont, Illinois) from 2016-2018. Currently, Christy is a volunteer for the Lemont Medical Reserve Corps Disaster and Humanitarian Relief and the vice president of Hope and Friendship Ministries Disaster and Humanitarian Relief.


Massage is generally considered part of complementary and alternative medicine and is an effective treatment for reducing stress, pain and muscle tension.  Massage is a natural way to release anxiety and fear. When patients can relax, pain is lessened and a sense of well-being has a chance to take over, allowing the patient to experience greater peace and ability to cope with what lies ahead.  Massage involves caring, safe touch — an invitation to relax, if you will.  Relaxation response may also decrease the physical effects of stress and the risks that come with it, such as anxiety, hypertension, cardiac arrhythmias, insomnia, fatigue, digestive disorders and psychological issues.  
  Patients will armor, a defense mechanism to guard their hearts against anxiety and fear.  When a patient armors, the shoulders contract in, causing the pectorals, serratus anterior, and subclavius to all contract. This involuntary response can increase pain and pressure on a patient affecting his/her breathing.  Massage performed in the pectoralis region, along with the ribcage, arms, shoulders, and hands will allow this to decrease and provide much needed relief from pain and anxiety.
As the patient declines and goes through the transition phase to the actively dying phase, he/she can experience increased levels of terminal agitation. Therapy will decrease the agitation, anxiety, and fear a patient may experience during these times.
 The pain medicines given to patients can cause constipation. Abdominal massage can decrease the discomfort caused by constipation. It can release gas bubbles trapped under the rib cage and in the abdominal region, as well as under the shoulder blades. The therapy used can allow that air to pass and increase the opportunity for a bowel movement.
 Patients affected by Parkinson’s/Huntington’s, dementia/Alzheimer’s, cancer, sickle cell crisis, pulmonary disease, and currently COVID 19 all can benefit from the therapeutic result of massage.  
   Emotional and mental benefits occur as well when a patient is given the opportunity to receive massage. Performing therapeutic massage on a patient takes time and perseverance. Most patients will be hesitant to accept help from a stranger, especially when that stranger is entering into a vulnerable place with the patient.  Hospital patients are already experiencing a roller coaster of emotions and thoughts. The last thing he/she wants to do is be put in a position to trust another medical professional. It takes time to develop a relationship with a patient. The therapist must tread lightly and tap into a psychological aspect with these patients in order to earn trust and be allowed into his/her protective bubble. Once that connection is made, consistency is key in continuing to allow that relationship to flourish and the patient to acquire the rewards from massage.  Overall, massage therapy is crucial and extremely beneficial to a patient facing a chronic illness and/or hospitalization. The combination of physical, emotional, and psychological are imperative to the healing process in an individual.

Dr Amberly Burger

Dr Amberly Burger, MD, MMM Beacon Health System, Indiana, USA

Title: Matters of the Heart: Palliative Care Interventions for Patients with Heart Failure

Dr. Amberly Burger is passionate about caring for patients suffering from serious illnesses.  She has developed two successful palliative care programs in Indiana.  Besides working as the Medical Director of Palliative Care Services, she is the Chair of the Ethics Committee at Elkhart General Hospital in Elkhart, Indiana, USA.  She enjoys teaching professionals the beauty of palliative care and aggressive support for patients.  Currently she is a speaker at Notre Dame University and teaches medical students.  Her favorite saying is, “Ask forgiveness, not permission.”


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.