DIALOGUE OFDIALOGUE OFPALLIATIVE PALLIATIVE

CARECARE

MS. IVA ATHAVIAMS. IVA ATHAVIA

Cancer Patients Aid AssociationCancer Patients Aid Association

Mumbai, IndiaMumbai, India

Email: ivathavia_17@yahoo.co.inEmail: ivathavia_17@yahoo.co.in

www.cancer.org.inwww.cancer.org.in

MEANING OF MEANING OF PALLIATIVEPALLIATIVE CARECARE

•To give or hand on.To give or hand on.•Be connected.Be connected.•Being in a close Being in a close relationship.relationship.

CHARACTERISTICS OF PALLIATIVE CARE

•Patient-centred, not disease-focused

•Total care: physical, psychological, social and spiritual

•Death accepting, but also life enhancing

•Concerned with healing, not curing•Multi-professional teamwork•Partnership with & empowerment

of the patient & family

Palliative Ovary cancer + Heart Patient at Hospice

OPENING OPENING DIALOGUEDIALOGUE

•‘Do you like to meet me ?’

•‘How can I help you ?’•‘What are you hoping ?•‘Will it effect you on positive way?’

IMPORTANCE OF IMPORTANCE OF GOOD DIALOGUEGOOD DIALOGUE

• To maintain trustTo maintain trust• To reduce uncertaintyTo reduce uncertainty• To prevent unrealistic expectationsTo prevent unrealistic expectations• To allow the person to adjustTo allow the person to adjust• To prevent a conspiracy of silenceTo prevent a conspiracy of silence• To devotion on patientsTo devotion on patients• To sustain interest To sustain interest • To willingness to listenTo willingness to listen• To keep patienceTo keep patience• To maintain good expressionTo maintain good expression

Palliative Stomach Cancer Patient

BAD DIALOGUE BAD DIALOGUE WITH PATIENTSWITH PATIENTS

•Confusion or chaos Confusion or chaos •Hampers interpersonal Hampers interpersonal

relationshiprelationship•Spoils atmosphere Spoils atmosphere •Hampers quality and quantity of Hampers quality and quantity of

servicesservices•Brings stress/tension/anxiety Brings stress/tension/anxiety •Leads to dissatisfaction, burn Leads to dissatisfaction, burn

out.out.

BARRIERS IN BARRIERS IN DIALOGUEDIALOGUE •Lack of experienceLack of experience

•Personal inhibitions or Personal inhibitions or limitationslimitations

•Fear of blame or criticismFear of blame or criticism•Fear of reaction Fear of reaction •Avoiding problems or crisis Avoiding problems or crisis

situationsituation• Dealing only with positiveDealing only with positive• Lack of acceptanceLack of acceptance

DON’Ts in the case of DON’Ts in the case of PALLIATIVE PatientsPALLIATIVE Patients

•Avoiding the patient Avoiding the patient •Ignoring cuesIgnoring cues•Small talkSmall talk•Switching the topicSwitching the topic•Use of medical jargon Use of medical jargon •Dealing with negatives, if anyDealing with negatives, if any•False hope & assuranceFalse hope & assurance

‘HEAD & NECK’ PALLIATIVE CANCER

PATIENT

DIALOGUE SKILLSDIALOGUE SKILLS• Appropriate eye contactAppropriate eye contact• Ask open ended questionsAsk open ended questions• Enquire about feelings Enquire about feelings • Encourage the expression of Encourage the expression of

emotionsemotions• Use sensitive prompting, Use sensitive prompting,

summarizing, and clarifyingsummarizing, and clarifying• Feel comfortable with silenceFeel comfortable with silence• Ask questions about mood and fearsAsk questions about mood and fears• Appropriate use of touch Appropriate use of touch • Allow appropriate use of your own Allow appropriate use of your own

emotionemotion

Important ISSUES of Important ISSUES of Palliative CarePalliative Care

•PainPain•FearFear•AngerAnger•AnxietyAnxiety

•DepressionDepression•LossLoss•ConfusionConfusion•WorthlessnWorthlessn

essess

TONGUE CANCER PATIENT

“H & N” Palliative Cancer Patients Face

with the Common Problems

•Trouble in swallowing •Persistent sore throat •New lump origin in every week •Ear pain, especially when swallowing •Mouth sore that do not heal •Hoarseness or difficulty in speaking

……………..2

•Spitting up blood & Change in skin appearance

•Chronic sinus infections, which do not respond

•Frequent headaches •Facial pain that does not go

away •Trouble in breathing through

the nose.

Palliative Lung Cancer + HIV.Aids Patient’s Home

Visit

WHY TO BREAK “BAD NEWS” IN PALLIATIVE

CARE

•To reduce fear and stress•To allow some time for the adjustment

•To utilise available support system

Why it is difficult?•Denial•Lack of time•Lack of privacy•Family collusion•Socio economic conditions•Lack of knowledge •Fear of facing the unexpected situation

TO IMPROVE PATIENT’S TO IMPROVE PATIENT’S QUALITY OF LIFEQUALITY OF LIFE

• Sympathy/ EmpathySympathy/ Empathy• Encourage expressionEncourage expression• Sharing - Interpersonal /groupSharing - Interpersonal /group• Prevent unrealistic expectationsPrevent unrealistic expectations• Reduce uncertaintyReduce uncertainty• Offer continued support and Offer continued support and

availabilityavailability• Acknowledgement and appreciationAcknowledgement and appreciation

“H & N” Palliative Patients Face with different

Psychological Problems •They do not have any outlet for their

emotions, •Many unresolved issues as – loss of

facial values, loss of speech,•Differences with the spouse attitude

(if young couple), availability of relatives.

•The Patients last wish to speak but cannot speak and relatives do not keep patience to understand patient’s psychology.

Palliative Mouth Cancer Patient

"H&N" Palliative Pts.in Grief The No. of 'H & N' Patients who

suffer from Deep Depression

The No. of 'H & N' Patients whoDo Not Sleep Due to TremendousPainThe'H & N' Pats.who are havingPsychological Problems Due toFacial ChangesThe No. of 'H & N' Patients whoFeel Bad to Meet Any One

The No. of 'H & N' Patients whoFeel They are the "Big Sinner"

The'H & N' Pats.whose LastWish to Speak With the Familybut Can't Speak

PEDIATRIC PALLIATIVE CANCER PATIENT

“The woods are lovely dark and deep,

And I have promises to keep,

And miles to go before I sleep

And miles to go before I sleep”

……………………………AROLE PLAY

Data has been collected from the following

Hospitals

B.Y.L. NAIR Charitable HospitalMumbai, India.

&Cama & Allbless HospitalMumbai, India.

THANK YOU