eol patama30july

WHY oriented palliative concept&

End of life care

Patama Gomutbutra MD.Chiang Mai university

End of life care

?“Palliative care”

End of life care Palliative care

?

Palliative care End of life care

?

?

Simon’s Golden cycle

Aim

Action

Assessment

Buddhism wisdom

Palliative care: Care for good

life

End of life care:Care for..

good death

WHY oriented palliative concept

Wish(Spiritual)

management

Illness (Symptom)

management

Disease (System)

management

Pro

gno

sis time

frame

Car

egi

ver

cap

acit

y:

You

, te

am, f

amily

, co

mm

un

ity

Gomutbutra 2012

Wish managementWhy:1. Focus energy in realistic hope2. Prepare for uncertainty

How : 1. Patient centered interview2. Prognosis & clinical assessment3. Team & family meeting

What : 1.Acceptance sign:

- clear goal, co-operation - No need “yes I have cancer”

2. Finish business task

?

Illness management

Why:1. Optimum pain, dyspnea control2. Prevent complication from distress

How : 1. Prognosis & Clinical assessment

2. Patient centered interview

3. Team & family meeting

What : 1. Symptom score

2. Function

Disease management

Why:1. Less caregiver burden (include us)2. Less suffering from futile treatment

How : 1. Team & Family meeting

2. Prognosis & Clinical assessment

3. Patient centered interview

What : 1. Caregiver (include us) well being2. Less emergency visit3. More death at home. Less in ICU

?

Comfort care suits(UCSF Hospital based hospice)

Home hospice singapore

You can fill by yourself ...

• Aims for “Why”

• Actions for “How”

• Assessments for “What”

Take home message

• End of life care as the shadow of palliative care :Expecting “good death” at anytime

• Start with “WHY”

pgomutbu@med.cmu.ac.th