PALLIATIVE CARE CASE
STUDY
Qamar Abbas
Deputy Medical Director
St Clare Hospice
PALLIATIVE CARE PROBLEM
• 49 years old patient Sarah admitted with history
of Breast cancer with chest wall extension and
lung metastasis for pain management.
• She has pain in arms, and chest wall
• Lives alone, divorced, three children age 17, 14
and 4. drug addiction history
• Very withdrawn
• Angry with nurses and doctors
• When medications prescribed, refused
medications most times.
PALLIATIVE MEDICINE
• An approach which improves QUALITY
OF LIFE of PATIENTS and their
FAMILIES facing 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.
Cancer pain relief and palliative care. Geneva; World
Health Organization: 2002
PHYSICAL ISSUES
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•
•
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Pain
Opioid side-effects
Breast wall infiltration
Lymphoedema
TOTAL PAIN
“It began in my back, now it seems that all
of me is wrong. I began to cry for the pills
and injections but I knew that I mustn’t.
The whole world seemed to be against
me. Nobody seemed to understand. My
husband and son were marvellous, but
they were having to stay off work and lose
their money. It’s marvellous to begin to feel
safe again.”
SOCIAL ISSUES
• Lives alone: care issues
• Financial issues
• Child care issues
PSYCHOLOGICAL ISSUES
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•
•
•
Withdrawn
Depression
Loneliness
Helplessness
EMOTIONAL ISSUES
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•
•
•
Divorced
Unloved
Fear for children
Unable to express love so that they do not
get too close and hurt
SPIRITUAL ISSUES
• Why me?
• If I do not take pills, it will speed it up…
• Can you give me something? I will not tell
anybody…..
PALLIATIVE CARE
CHALLENGES
• Clinical Knowledge of diseases and their
progress
• Symptom Management
• Communication skills (listening)
• Ethical dilemmas
• Patient empowerment
• Staff issues: Self-knowledge, Team
membership, Reflection
• Personal issues: Empathy, Patience,
Courage