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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”
