Pallativecare Conference 2019
About the Conference
This conference is designed to provide primary care practitioners with up-to-date, evidence-based information on commonly encountered in Geriatrics, Palliative Care, and Psychiatry medical issues, while suggesting pragmatic approaches to clinical management. The discussion-based format of the conference will encourage audience participation through dynamic lectures, case-based studies and hands-on workshops. Keynote speakers will present and critically assess recent advancements and industry updates in Geriatrics, Psychiatry and Palliative Care for Primary Care, with the goal of enhancing the knowledge should improve attendees’ confidence in base and core competence of attendees. The successful completion of this interactive program diagnosing, treating, and prescribing the most effective courses of treatment, with the ultimate goal of improving patient outcomes. Palliative care is an approach to care that aims to achieve the best quality of life for the terminally ill, persons who face a debilitating chronic condition, and their families according to the individual’s goals of care
· Minimize suffering
· Treat all active issues
· Prevent new issues from occurring
· Address person’s physical, psychological, social, and spiritual issues, and their associated needs, hopes and fears
· Promote opportunities for meaningful and valuable experiences, and personal and spiritual growth
· Prepare for and manage end‐of‐life choices
· Help families and survivors cope with the challenges of providing care, as well as with loss and grief.
Palliative Care Market: Increasing rate of life-threatening diseases such as cancer, cardiovascular and infective diseases is anticipated to be the major growth driver for the global palliative care market. Number of Palliative care centers also increasing worldwide. The high cost of the treatment can be a major restraint for the global palliative care market. The global palliative care market has been classified on the basis of service type Private residence care and end user and geography.
- Hospice inpatient care
- Hospital inpatient care
- Nursing home and residential facility care
- Home Care Settings
- Palliative Care Centers
- Long Term Care Centers & Rehabilitation Centers.
According to the Organization for Economic Co-operation and Development (OECD), in 2010, the United States spent over $8,000 on each person’s health. In comparison, most of Europe spends an average of $3,500 USD on each citizen’s health per year. Even the next highest spending country in the OECD, Norway, only spends $5,300 USD per citizen each year. In contrast, the WHO reports that nearly thirty million people die each year from diseases that require hospice care. While palliative care is a recognized subspecialty in England and Ireland, other European countries are just now beginning to develop certification for hospice care. Where Americans fail to seek hospice care, Europeans request it but find the quality of care to be lacking. One report from the Care Quality Commission in the United Kingdom states that forty percent of hospitals are in dire need of improving their hospice programs. According to the European Association for Palliative Care (EAPC), there is a push to improve not only the quality of care patients receive, but also to normalize health care standards across facilities, with continued efforts to improve in the foreseeable future. Regardless of your financial status or background, end of life care is a very serious topic when you realize the end may be near.
The global market for palliative care is expected to flourish over the forecast period of 2017-2027 due to increasing awareness about physical, social and psychological, needs of patients with life-threatening diseases and their families. Majority of people receiving hospice care are the cancer patients, according to WHO. The global market for palliative care is expected to flourish over the forecast period of 2017-2027 due to increasing awareness about physical, social and psychological, needs of patients with life-threatening diseases and their families. Moreover, a growing number of Palliative care centers worldwide, extending application for homecare, increasing number of qualified physicians for Palliative care center and expanding aging demographics are some of the factors responsible for the rise in the global Palliative care market. The hospice and palliative services market is therefore establishing in these markets and will be in great demand with increasing awareness.
Palliative Care and Nursing
Nurses represent the largest group of health-care professionals all over the World. Nurses are a vital resource for ensuring the provision of safe and effective care for the global population. Nurses spend more time with patients and families than any other health professional as they face serious illness. Palliative care refers to the optimization of quality of life for both the patients with serious illness and their families using special measures to anticipate, treat, and prevent suffering. Palliative care can be provided concurrently with curative measures. Concurrent care is different than a traditional hospice model, where curative therapy, or life extending measures such as palliative chemotherapy, generally has ceased. The concurrent model of palliative care may be, particularly important in lower and lower middle-income countries where access to curative care is limited. Like geriatrics and hospice, palliative care generally will use a multidisciplinary team that may be made up of nursing, social work, spiritual care, and medicine to meet the multifaceted needs of patients with serious illness, or who are at the end of life. Many nurses involved in palliative care face the challenge of combining the art of caring and the science of medicine into a cohesive model that reflects compassionate, individualized care regardless of the environment. Palliative care nursing demands intense critical thinking, heightened levels of mental functioning, and the ability to utilize complex palliative nursing skills.
Palliative Care & Hospice Nursing
Hospice and palliative care both offer compassionate care to patients with life limiting illnesses. But palliative care which is always a component of hospice care – can be used as a separate area of medical practice while the patient is receiving treatment. Hospice care includes palliative care and addresses the patient’s physical, emotional, and spiritual needs as well. Hospice can help with such daily activities as administering medications, bathing, and dressing, but hospice does not provide full time caregivers. Hospice requires that a willing, able and available caregiver be in the home, unless alternate arrangements are made. Palliative care is also focused on relieving symptoms associated with the patient’s condition while receiving active treatment.
Palliative Care & End of life care
Standards of end-of-life care and palliative care have been mutable over the last few decades. This is partially due to a lack of understanding about the differences between end-of-life care and palliative care. The differences are very explicit and important as decisions and plans are made for patients and their significant others. The concepts are similar but not the same. . End-of-life care requires a range of decisions, including questions of palliative care, patients' right to self-determination (of treatment, life), medical experimentation, the ethics and efficacy of extraordinary or hazardous medical interventions, and the ethics and efficacy even of continued routine medical interventions. End of life and palliative care aims to help you if you have a life-limiting or life-threatening illness. The focus of this type of care is managing symptoms and providing comfort and assistance. This includes help with emotional and mental health, spiritual and social needs. End of life and palliative care provides practical help with daily tasks as well. The goal is to improve your quality of life and that of your family, friends and carers. End of life and palliative care is based on what your needs are, not your diagnosis. If you have an illness that cannot be cured and will lead to the end of your life, end of life and palliative care will be suggested.
Palliative care in Oncology
Palliative care can be meaningfully used at any stage of a serious illness—including circumstances where it is provided concomitantly with curative therapy. Helping a person’s symptoms and side effects is a crucial part of cancer care. This style of treatment is called symptom management, supportive care, or palliative care. Palliative care gives professional treatment and gives the treatment against the symptoms, their side effects and emotional problems. Palliative care is given amid a patient's involvement with cancer. Primary palliative care is provided on a regular basis by the longitudinal oncologist and care team. Secondary palliative care is provided by teams of individuals with dedicated expertise in this discipline. This resource can be provided either in outpatient programs or in an inpatient unit. Tertiary palliative care is provided by specialized teams of providers with advanced expertise in the management of symptoms and pain, including but not limited to implantable drug delivery systems, palliative sedation, and management of advanced delirium.Cancer symptoms may incorporate pain, sickness, vomiting, fatigue, depression, constipation, diarrhea, confusion or shortness of breath. Palliative Care authorities are expertise to interpret the complex medical statistics and can enable you to understand.
- Oncological Nursing
- Therapeutic Radiology
- Clinical Oncology
- Tumor associated Pain
- Surgical Oncology
- Alternate Medicine
- Geriatric Oncology
- Practical aspects of Supportive Palliative Care
- The extremes of Supportive Care
- Early Palliative Care in Oncology
- Supportive care as a comprehensive approach
Palliative Care in Genetic Disorders
Genetic disorders may likewise be complex, or polygenic, multifactorial, triggered by at least one gene abnormalities. Currently, very little research detailing issues that are looked toward the end of life for individuals with genetic disorders, and there is an absence of a good model of care to pursue for end-of-life treatment or withdrawal of treatment. Technological advances have extended life for various individuals with genetic diseases. The fend of-life program has sources in the hospice development with individuals experiencing genetic disorders. A nurse assists the sick patient to make the most of living.
- Molecular Genetics
- Gene Therapy
- Bioinformatics and Genomic Technology
- Genomic Diseases and Related Disorders
- Congenital Disorders
- Chromosomal Disorders
- Clinical Genetics and Dysmorphology
Aging and Gerontology
Critical Gerontology is concerned with physical, mental- social aspects and implications of aging. The field of gerontology is actually quite broad, containing many professionals who focus on various aspects of aging and development. While it could be considered as one large field, it actually consists of many smaller fields all working together with a united focus on middle-aged and older adults.
- Aging and Bio-gerontology
- Aging and Socio-gerontology
- Aging and Psycho-gerontology
- Aging and Applied Gerontology
- Aging and Applied Gerontology
- Aging and Clinical Gerontology
- Aging and Experimental Gerontology
- Aging and Translational Gerontology.
Gerontology is the scientific study of aging as a physical, cultural and social process. The study is often academic, involving researchers in diverse, multidisciplinary fields. These fields tend to look at four specific areas in gerontology. Beyond the focus on the elderly, however, gerontology and geriatrics have a number of important differences in how gerontologists and geriatricians approach the elderly and how they ultimately contribute to the field of elder study and care.
Gerontologists tend to have specific research areas in one or more of these categories, each contributing to the greater body of knowledge of aging as a whole. A gerontologist with training in psychology and behavioral science might, for example, want to focus on how aging influences self-perception and mood. Researchers trained in public policy might focus on how governments accommodate older populations. Physicians with a focus on geriatrics work to help older patients with the physical changes their bodies experience as they age. From performing physical examinations to recommending treatments and procedures in the event of age-related health complications, geriatricians approach aging with an eye for hands-on care in mind.
Geriatric Nursing & Elderly Care
Geriatrics is a field of medicine that deals with the care of elderly people. Geriatric nurses are some of the most important professionals in this field, as they often provide daily care for geriatric patients. Since the human life expectancy has increased and the members of the Baby Boomer generation have started aging, the demand for geriatric nurses is expected to increase dramatically.
Because of their fragile health, elderly individuals often need special care, particularly since a minor health related issue can sometimes spin out of control quickly in the elderly. A geriatric nurse, or gerontological nurse, is a type of nurse that helps care for aging and elderly individuals. They are trained to be able to perform traditional nursing duties, yet they also have special training that helps them better understand the special needs of many elderly people. This extra training enables them to for aging patients with relative ease.
Working as a geriatric nurse is often very gratifying and rewarding personally. However, it takes a special type of person to work in this field, and the work can also be frustrating or disheartening at times as well. If you are looking to become a geriatric nurse, you must keep in mind that the aging process affects everyone differently. While some elderly patients are somewhat content or even happy-go-lucky, others may be sad, scared, or even angry that their health is failing.
When it comes to geriatric nurses, they can learn the positive aspects of caring for the elder people. They should make a close affection with the patients by learning their stories. These nurses should be taught how to balance work and stress simultaneously. It is also important to reduce their fearful and the negative attitude about the geriatric nursing.
Older patients with endocrine disorders often suffer from multiple chronic medical conditions that can complicate and confound clinical manifestations, evaluation, and management. The presence of concomitant comorbidities, medications used to treat these conditions, and changes in nutritional status may affect and confuse the biochemical evaluation of endocrine disorders (e.g., alterations in thyroid function tests by non-thyroidal illness, so-called thyroid sick syndromes, or alterations in sex hormone binding globulin, SHBG, by illness, medications or aging that lower total testosterone levels but may not affect free testosterone levels). For example, hyperthyroidism in an elderly patient with preexisting coronary and conduction system disease may present with atrial fibrillation and a slow ventricular response, whereas in another equally hyperthyroid patient with a prior stroke, it may present with confusion or depression; neither patient may tolerate hyperthyroidism long enough for the classic thyroid-related manifestations (e.g- goiter) to become apparent. Third, elderly patients often have multiple diseases and take many medications that may mimic or mask the usual presentation of endocrine disease.
Clinical pharmacology has an important role to foster the linkage of the principles of geriatric medicine and disease-based therapeutics. In geriatric medicine advances in understanding the interplay of multiple concurrent illnesses and how this may result in a common path to patient disability and death has allowed definition of the frailty syndrome In addition, the concept of competing morbidity, such that in the older patient successful treatment of one illness may result not in restoration of health, rather in the more obvious clinical presentation of another concurrent illness, has advanced clinical decision making and end of life care. The clinical pharmacologist has an important role in teaching the changing balance of risk and benefit for specific drug therapy intervention in the context of the individual older patient and their specific concurrent illnesses. The research opportunities in this area for the clinical pharmacologist are both challenging and exciting.
The multidisciplinary health care team is championed by geriatric medicine as the optimal means of providing care for the complex older patient with multiple concurrent illnesses. The clinical pharmacologist has a key role on, working closely with the primary geriatric medicine clinician, the clinical pharmacist, and other members of the team to individualize and modify complex drug therapy regimens as the clinical status of the older patient evolves over time. Many elders need a "medication manager," perhaps a pharmacist, nurse, or primary care physician. A pharmacist can oversee and coordinate the prescriptions.
Neurodegenerative Disorders & Dementia
Neurodegenerative disease is an umbrella term for a range of conditions which primarily affect the neurons in the human brain. This degradation can affect body movement and brain function, causing dementia (progressive or chronic decline of cognitive function that affects memory, thinking, behaviour, language, calculation, learning and emotion capacity, and should never be associated with a normal aging process) Neurodegenerative diseases have a major impact at professional, social and family level of patients and can lead to a complete inability to carry out any type of everyday activity. For example, patients may have: motors problems; breathing difficulties; cognitive problems or gradual memory loss (possibly affecting the memory of all that has been learned over a lifetime). Neurodegenerative diseases are incurable and debilitating conditions that result in progressive degeneration and / or death of nerve cells. This causes problems with movement (called ataxias), or mental functioning (called dementias).
Dementias are responsible for the greatest burden of neurodegenerative diseases, with Alzheimer’s representing approximately 60-70% of dementia cases.
The neurodegenerative diseases that JPND focuses on are:
- Alzheimer’s disease (AD) and other dementias
- Parkinson’s disease (PD) and PD-related disorders
- Prion disease
- Motor neuron diseases (MND)
- Huntington’s disease (HD)
- Spinocerebellar ataxia (SCA)
- Spinal muscular atrophy (SMA).
Palliative Care & Psychiatry
Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this assessment are to briefly define palliative care and summarize the evidence for its benefits, to describe the roles for psychiatry within palliative care, to review recent advances in the research and practice of palliative care psychiatry, and to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice. In a recent multi-site randomized controlled trial, Dignity Therapy (relative to client-centered care or standard palliative care) was associated with greater levels of perceived helpfulness, improved quality of life, greater sense of dignity, and a higher degree of helpfulness to the family. Of note, there were no significant differences in global distress levels, the primary outcome. . Quite often, the care of patients who experience serious psychological distress in the situation of a serious illness requires input from clinicians with expertise in psychiatric diagnosis and treatment.
Palliative Care & Emergency Medicine
A palliative care scenario was designed and implemented in the recreation program at an urban academic emergency department with a 3-year EM residency program. EM residents attended one of eight high-fidelity simulation sessions, in groups of 5–6. A standardized participant portrayed the patient’s family member. One resident from each session managed the scenario while the others observed. A 45-min debriefing session and small group discussion followed the scenario, facilitated by an EM simulation faculty member and a resident investigator. Palliative care in the emergency department (ED) is limited yet promising. Research supports the use of palliative care interventions early in the disease trajectory to promote quality of life, as well as reduce costs associated with treatments. The ability to change the existing paradigm of care for chronic diseases, such as cardiac or respiratory diseases, stroke, cancer and diabetes, is an opportunity for palliative medicine - specifically palliative care in the ED - to alter the trajectory of care. Many ED palliative care delivery systems have emerged as providers design programs to meet the needs of diverse stakeholders resulting in three recurring models of palliative medicine/care which are ED-palliative care partnerships; ED palliative care champions; and ED hospice partnerships. Best practices in palliative care were highlighted along with focused learner performance feedback. Participants completed an anonymous pre/post education intervention survey.
Palliative Care & Health Issues
The word “homeless” has become both a negative descriptor and a stereotype in our society. We posit that the provision of hospice palliative care is structured on several problematic assumptions: an expectation that patients will have an informal support network (family and friends), a stable and secure residence, a predictive terminal illness trajectory, and reasonable access to health care. Homeless individuals have considerable experience with death and dying, and qualitative research has shown them to hold the expectation that their death will be both sudden and violent. Here, we look at the current data concerning known disparities in access to good palliative care services experienced by the homeless population, based on a stakeholder analysis of the available literature. That information, coupled with the use of a public health ethics decision-making tool, such as the Good Decision Making in Real Time framework, is used to explore the common ethics challenges that can arise in public health interventions aimed at the provision of end-of-life care to homeless adults. A broad exploration of the system that underlies our care is critical to the proper and appropriate provision of care for homeless individuals.
Palliative Care in Rehabilitation and Occupational Medicine
Occupational therapy (OT) is a person-centered health profession concerned with promoting health and wellbeing through occupation. The primary goal of occupational therapy is to enable people to participate in activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement. Occupational therapists work within an interdisciplinary framework in which medical and allied health professionals consider all relevant treatment options and develop collaboratively a separate treatment and care plan for each person. In a comprehensive cancer care setting, allied health clinicians are essential to the provision of tailored assessment of the person’s changing status throughout all stages of the person’s cancer experience4. Within the field of oncology occupational therapists deliver care to a wide range of age groups across a variety of care settings including (but not limited to) hospital, home, inpatient palliative care units and community based services. Provide interventions including education, rehabilitation, retraining in ADL, environmental modification and prescription of equipment to support recovery and adaptation y Educate on symptom management to improve functional status and engagement in occupation, e.g. breathlessness, comfort, pressure care, cancer related fatigue, pain, cognition impairment, sensory and neurological disturbances and upper limb dysfunction.
Alternative Healthcare in Palliative Care
Complementary and alternative medicine has also become part of the education and research mission of academic medical centers. Programs have been established at some of the most prestigious medical centers in the US including the Complementary and Alternative Medicine Program. First, the availability of the therapy to patients is dependent on the availability of students and instructors from the schools. Continuity of care is interrupted when students are on breaks or vacation. Second, students require appropriate supervision. If instructors are not available, treatments cannot be given. In Palliative care It incredibly improves the quality of life, It won’t lengthen it, but it won’t shorten it either and there will be no side effects. Plus, It gets the added benefit of meeting some very terrific human beings. To me, what more can you ask for except the opportunity to spread the word
There some objectives to follow to achieve Alternative Healthcare in Palliative care:
- Describe the prevalence of Complementary and Alternative Medicine practitioner and product use in the outpatient population of palliative care centers.
- Describe the characteristics of Complementary and Alternative Medicine users the outpatient population of palliative care centers.
- Estimate the Complementary and Alternative Medicine expenditure of the outpatient population of palliative care centers.
- Describe the rates of disclosure of both Complementary and Alternative Medicine and conventional health care to health professionals by the outpatient population of palliative care centers.
Palliative Care for Psychiatry & Neurological Disorders
There is a substantial and growing need for neurologists to apply the principles of palliative medicine to the care of patients with progressive, chronic illnesses. Neurologic diseases are largely incurable, reduce life expectancy and are associated with pain, depression, and other symptoms that are difficult to control. Miyasaki et al. showed that symptom burden in advanced Parkinson disease (PD) is similar to that in metastatic cancer. Caregivers of neurology patients also have similar, if not higher, rates of distress and burnout as caregivers of patients with cancer. The place of death and documentation of advance directives offer objective measures of physician performance. Hospital deaths among patients with chronic neurologic disorders are high for multiple sclerosis (MS). However, hospice deaths are extremely uncommon in PD and MS: 0.6% and 2.5%, respectively. These are striking statistics because research overwhelmingly indicates that the majority of patients prefer to die at home. All physicians, including neurologists, should have familiarity and comfort with several fundamental palliative care skills including communicating bad news, nonmotor symptom assessment and management, advance care planning, and caregiver assessment. For more complex or advanced patients, referral to palliative care specialty teams may be appropriate, including inpatient palliative care consultation, outpatient palliative care clinics, home palliative care, or hospice.