5^th World Congress on Hospice and Palliative Care 18-19, July-2018 Melbourne Australia

Biography:

Abstract:

In Germany, Children and youth hospice work is a very dynamic field which, during the last 25 years,they as continued to establish, develop and professionalize itself  in the German hospice and palliative movement. Since 2015, impulses for quality advancement are given by the “Qualitätsindex  für  Kinder‐  und  Jugendhospitzarbeit”  (Quink), a nonstandardized questionnaire tool which was developed by a research team in cooperation with the deutsche Hospiz- und PaliativVerband e. V. (DHPV). The track gives an overview of the current situation of children and youth hospice work in Germany and introduces Quink as an innovative, reflexive quality management tool.

Biography:

Abstract:

Scant literature has been published in Singapore on the various end of life cultural practices. A few examples are illustrated. No touching of the body after the last breath for 8 hours: Mr C a Tibetan Buddhist with terminal cancer of the colon; was keen to have Buddhist rituals given to him prior to and after his death. Just before his demise, Monks performed rituals and holy chants. Relatives refrained from crying as it may hinder a happy rebirth. They also placed holy garments on the patient before death.At his death, the family carried on their vigil and prayers by placing Buddhist pictures and their meditation beads in his hands. Tibetan Buddhists believe the soul is still around in the body until 8 hours after death.Last words heard must be Holy: Mr A was a Muslim engineer dying from liver failure.  His sister was not able to read the Muslim Yassin as she was “unclean during her menses". Our Muslim staff read the Yassin, and he passed away peacefully. His sister was satisfied that the brother had heard the Holy Quran just before his last breath as listening to Sura Yaseen  will ensure that  he will die a martyr. Rice, milk and Ganges water gave prior to death.: Mdm S had been on intubation for months. As her BP started to decline and the doctors pronounced she was gravely ill the family asked permission toplay holy music and placed some Ganges water on to her lips. Each family member gave her one teaspoon of milk along with a few grains of rice at her lips. Doing these rituals will help her reach “MOKSHA “or salvation.Conclusion: Being culturally aware of these customs and practices in a multicultural society like Singapore is essential  in ensuring a “Good Death”.

Biography:

Olly Zekry obtained her Bachelor of Pharmacy and Post Graduate Diploma in Hospital Pharmacy from the University of Tasmania. She completed her Masters of Science Medicine Pain Management from Sydney University. Olly is now unit coordinator for the pharmacology components of the Masters course with the Pain Management Research Centre in the Department of Medicine, Sydney Medical School at the Royal North Shore Hospital. She has had a strong interest in education and teaching for many years. She has had international publications including Subanesthetic, Subcutaneous Ketamine Infusion Therapy in the Treatment of Chronic Nonmalignant Pain, and Conversion of Gabapentin to Pregabalin with Professor Stephan Schug. She also works as a Consultant Clinical Pharmacist in the Pharmacy Department at the Royal Prince Alfred Hospital at Camperdown, Sydney. Olly won the Quality Use of Medicine (QUM) Award for Management for Pharmacists across Australia in 2014. Olly also does Home Medications Reviews in Sydney but mainly in the rural areas of NSW such as the Blue Mountains. Olly was involved with the ketamine project at the Royal Prince Alfred Hospital Pain Management Centre and has presented posters and presentation overseas at major international pain conferences In Milan Italy, Toronto Canada, and Rotorua New Zealand for the Pain Management Centre. Olly conceived the program for the Pharmacology Workshop for the 2015 Australian Pain Society (APS) Annual Scientific Meeting in Brisbane and was responsible for generating the presentation topics for the many esteemed international and domestic speakers. She was invited to continue in the role and was the organizer and chairperson for the Pharmacology Workshop in Adelaide 2016. Ms Zekry presented at the 5th Annual World Congress of Geriatrics and Gerontology-2017 (WCGG-2017) held in Fukuoka, Japan in December 2017. She is again organizing and chairing the Pharmacology Workshop for the Joint APS / NZPS ASM in Sydney on Sunday 8 April 2018.

Abstract:

Opioids are commonly used for pain control in palliative care settings. Accumulation of active metabolites of opioids can cause a wellrecognized toxidrome including sedation, hallucinations, myoclonus, seizures, and cognitive dysfunction. Sedation, which is the most commonly seen symptom of toxicity, leads to delirium and obtundation. Opioid toxicity is often associated with the amount ingested and its speed of absorption in the body. This can have life-threatening effects on various body systems. Gaining expertise with the use of hydromorphone for chronic pain management should be the primary goal of those managing pain in the terminally ill patient. There is a wide choice of routes of administration and the adverse effects may be minimised by careful dose adjustment, particularly in patients with renal failure or in the elderly. When alternatives are indicated for more severe pain, methadone or fentanyl may be considered. When a patient is not responding to opioids, review the pain diagnosis with the causes of opioid-insensitive pain in mind, particularly bone and neuropathic pain. Rotation of the one opioid to another should be considered. Co-analgesics or one of the recently developed NMDA receptor antagonists may also be required. We will discuss a case study involving Anne-Marie, a 65 years old female with: ï‚· Refractory myeloma ï‚· On a regular dialysis program ï‚· Chronic back pain. She was due to commence radiotherapy to the femoral lesion and was admitted to RPA with escalating pain & severe drowsiness. She complained of pain everywhere, but it was worst in the left femoral and left L2/3 spinal regions with decreased mobility and sudden cramping. Her analgesic medication: ï‚· Fentanyl patch 175mcg/hr every 3 days ï‚· Fentanyl lozenges 200mcg Q4h prn if inadequate relief ï‚· Hydromorphone S/C 5mg Q4h and PRN with rapid escalation by renal team ï‚· Gabapentin 200mg pre dialysis and 400mg post dialysis Finally, a discussion about opioid induced neurotoxicity and management will be presented.

Biography:

Abstract:

Death is a truth and reality.  However, “…….our ultimate goal, after all, is not a good death, but a good life to the very end ”- Atul Gawande, Being Mortal: Medicine and What matters in the End. Most people would prefer to die at home and statistics shows an increasing trend towards. In 1980, 70% US cancer patients died in the hospitals and the number had dropped to 37% in 1998 and further to 22%. Pain is a frequent symptom in patients under palliative care and highly prevalent in the four months prior to death due to nociceptive or neuropathic mechanism or both types. Effective management of pain in elderly patients will reduce the disability and improves the quality of life to the very end. Unfortunately, many barriers huddles with effective management of pain symptom include patient factors such as misconceptions about pain and its treatment, fears and concerns about pain and its medications and barriers related to providers such as lack of knowledge , skills and time for adequate assessment of pain and other symptoms.  In addition, elderly has highest prevalence of comorbidity and age-related alteration in the pharmacokinetics and pharmacodynamics, which makes the pain treatment more complex. Chronic pain encompasses a complex array of sensory-discriminatory, motivational-effective and cognitive –evaluative factors. Because of these factors, the control of pain symptom should be approached in multidisciplinary way consist of pharmacological and with more emphasis on non-pharmacological modalities

Biography:

Abstract:

Palliative care is an integral component in cancer care. Palliative care is holistic care. Correctable problems should be corrected at the right time rather than waiting for the terminal stage of the disease. Objectives: To evaluate the referral pattern followed in the tertiary cancer care Centre. Methods: A retrospective method of study was adopted to quantify the time gap between the first patient admission in cancer care and palliative care referral in-order to improve the quality of life of patients by the way of improving the referral system.  Results: Out of 396 patients analyzed 209 (52.8%) were male and 187 (47.2%) were females. The mean age was 52.94 years (SD ± 14.007). Majority 59.3% (N=235) of patients fall under late adult category. Most of them were diagnosed with head and neck cancer 102 (25.8%), and reproductive system cancer 88 (22.2%). At follow up 204 (51.5%) were alive and 192 (48.5%) were dead. Among this Patients died within six months were 180 (45.5%) from the time of registration at pain and palliative care clinic. Many of the patients (51.5%) were referred to pain and palliative care clinic within one year from the time of their registration at hospital. Conclusion: Palliative care improves the quality of life of people with life-threatening or debilitating illness by providing relief from pain and other physical symptoms and care for psychosocial needs. To ensure the most effective care for patients, palliative care begins at the point of diagnosis, continues throughout treatment, and bereavement support is offered to the family after the patient’s death.

Biography:

Dr. Hiromichi Matsuoka has expertise in evaluation and passion in improving the health and wellbeing. He has built his backgrounds as an anesthesiologist, physician of psychosomatic medicine, and palliative care doctors after years of experience in research, evaluation, and teaching both in hospitals and education institutions. Now he is in University of Technology Sydney and proceeding his research in patients with cancer pain.                   

Abstract:

Purpose: Management of cancer-related neuropathic pain refractory to opioids remains challenging. We have investigated the additional efficacy of duloxetine for cancer-related neuropathic pain refractory to opioids and gabapentinoids.

Methods: A multicenter, randomized, double-blind, placebo-controlled trial. Patients with any cancer-related neuropathic pain, currently taking opioids, non-responsive or intolerant to gabapentinoids were eligible. Diagnosis of neuropathic pain was based on the International Association for the Study of Pain (IASP) algorithm. Patients with chemotherapy-induced peripheral neuropathies were excluded. Patients were administrated 20 mg to 40 mg of duloxetine or placebo for 10 days. The primary endpoint was the average pain intensity (Brief Pain Inventory (BPI) item 5) at Day 10 (BPI d10).

Results: 70 patients were enrolled at 12 sites. BPI on Day0 (before treatment) were 5.6 in group D (duloxetine) and 5.7 in group P (placebo). BPId10 was i) average of group D 4.03 [90% CI 3.33, 4.74], group P 4.88 [4.37, 5.38] (P = .053) (Complete Case: CC analysis); ii) group D 4.06 [3.37, 4.74], group P 4.91 [4.41, 5.41] (P = .048) (Baseline Observation Carried Forward: BOCF analysis). Point estimate of the difference of average values between the two groups was -0.84 [-1.71, 0.02] (CC analysis) and -0.85 [-1.69, -0.01] (BOCF analysis). Compared to Day 0, the improvement rate of 30% or more, and 50% or more at Day 10, were 44.1% in group D, 18.2% in group P (P = .022), and 32.4% in group D, 3.0% in group P (P = .002), respectively. Although there was one case of discontinuation of adverse events in Grade3 (CTCAE version 4, JCOG), it was due to deterioration of the primary disease and there was no relation with protocol treatment.

Conclusion: Duloxetine is clinically effective for cancer-related neuropathic pain

Biography:

Urmi chavan has completed her Masters from Sheffield Hallam University, UK. She is currently working with a private physiotherapy clinic in UK and is an aspiring PhD student. She has done past research in the field of physiotherapy in dementia and has two publications on her name

Abstract:

Biography:

Beaven Andrew A. Atienza is an Associate Professor in MSU-Iligan Institute of Technology, Philippines. He has completed his Master’s Degree from Mindanao State University-Marawi.  He has presented numerous research papers in international ocnferences  in Hongkong, South Korea, Malaysia, Singapore, Bangkok, etc... and has published  4 papers in reputed journals.

Abstract:

Intellectual and Developmental Disabilities is a lifelong challenge with a considerable effect on the lives around them.  The high quality of care needed by a mentally handicapped child can become psychologically, emotionally and physically stressful to parents and/or caregivers. Although there have been numerous studies conducted to determine the burdens of families with a mentally retarded member around the globe, little was known about the association of the caregivers care-related constraints and their quality of care. This study aimed to determine the practical, emotional and psychological constraints that exist in caring mentally disbled children and its relationship to caregivers’ quality of palliative care. The respondents were the primary caregivers of the mentally disabled children studying at Iligan City SPED Center, selected through random sampling technique. Data generated by the questionnaires were analyzed and interpreted using SPSS . High quality care was positively associated with caregivers’ capability in responding to practical concerns such as providing constant supervision to the mentally retarded child. Caregivers’ emotional constraints like being embarrassed with the mentally retarded child and having a sense of inadequacy in caring the child can adversely affect their quality of care. Being able to manage generalized anxiety disorder in the part of caregivers has a positive impact in their quality of care to mentally retarded children. These findings may shed light on the struggles that caregivers face as well as to ascertain the need for awareness and support for such challenged families in order to provide quality care to mentally retarded children.

Biography:

Mrs. Wahyu Dewi graduated from National Cheng Kung University, Taiwan with speciality in palliative care. She has conducted the first Indonesia study to develop of Component of Good Death Indonesianversion that reflected advanced cancer patients’ perspectives and beliefs in Muslim cultures. Before that, she also did several literature reviews regarding palliative care. The purpose of all her studies is to develop palliative care system in her country which is still at the stage of infancy.

Abstract:

Statement of the problem: Good death has already been defined by previous studies. Most of them stated that good death definition included comfort which reflected as no suffering with physical and psychological comfort, support and connection to others and spiritual well-being. Some of them add several domains such as preparation of death, respected as individual and life completion. A good death may be influenced by personal values, social context, religions and cultural contexts, evidenced by different perspectives of some countries. Indonesia is a multicultural country and the most populous Muslim-majority country. Therefore, the purpose this study is to understand the components of good death among advanced cancer patients under Indonesian culture. Methods: A cross-sectional survey was conducted with convenience sampling in Central Java, Indonesia. Exploratory Factor Analysis with principal axis factoring and promax rotation was used to identify the domains of good death. Descriptive statistic was applied to present each domain and determine the important component of good death. Result: A total of 363 patients with advanced cancer were recruited. After factor analysis of the Components of Good Death questionnaire, 52 items were kept and covered by 5 domains. They were named as comfort, support & faith, dying with dignity, life completion and death awareness & death preparation and explained 51.87% total variance. The most important domain of good death is support & faith (M=6.28), whereas death awareness and death preparation (M=4.42) is the least important domain of good death. Conclusion: The findings represent advanced cancer patients’ perspectives regarding good death under Indonesian culture and beliefs. It can be used as a guidance to improve quality of care or end of life care for cancer patients, particularly in understanding what the patients desperately wants in the end of their life to achieve good death.

Biography:

Abstract:

“What to do with the dying?” it's a daily question for me, because I have been dealing with this problem for 34 years, the first 18 of which as a medical oncologist and the last 16 as a palliative doctor in the Hospice of the Casa di Cura “Beato Palazzolo”, the first Hospice to be opened in Bergamo in 2000. Over these 16 years I have cared for 3,300 patients in the last phase of their life, often sitting by their bedside and watching over them as they died. I think we have three choices: to remove death, to abolish the dying, to accompany the dying in such a way as to enable them to experience death as the last stage of their growth. So, what can we do? We must learn to be able to understand their needs and to stay with them and their families, protecting the uniqueness of their person in the face of an imminent death.

Biography:

Abstract:

The essence of palliative care is to provide health services for managing patient’s symptoms, reduce their pain, and improve their quality of life. In Morocco, the incidence of cancer is increasing; around 50% of patients are diagnosed at advanced stage. For most them, only palliative treatment and pain relief can be considered. This article is interested on the current situation and challenges of palliative care in Morocco. Currently only three centers devoted to palliative care are functional in Morocco, in Rabat and Casablanca with very restricted bed capacity. The area of coverage is very restricted and palliative care services can be provided by medical or radian oncologists affected in different region of the country, which still insufficient. National Cancer Prevention and Control Plan (NCPCP) make the promotion of palliative care as an important and strategic element of healthcare system, the objective is to be aligned on the WHO recommendations to ensure palliative care and pain treatment for all Moroccans whose need it

Biography:

Dr. Hiromichi Matsuoka has expertise in evaluation and passion in improving the health and wellbeing. He has built his backgrounds as an anesthesiologist, physician of psychosomatic medicine, and palliative care doctors after years of experience in research, evaluation, and teaching both in hospitals and education institutions. Now he is in University of Technology Sydney and proceeding his research in patients with cancer pain.                  

Abstract:

Background: Management of cancer patients suffering from neuropathic pain refractory to opioids and gabapentinoids remains an important challenge. Duloxetine is one of the choices after first-line treatment fails. The efficacy of duloxetine has been reported in non-cancer patients and in chemotherapy-induced polyneuropathy, but no randomized clinical trials have examined its effects on neuropathic cancer pain refractory to first-line treatment.

Methods: A multi-institutional, prospective, randomised, double-blind, placebo-controlled, two-parallel trial is planned. The inclusion criteria are adult cancer patients suffering from neuropathic pain refractory to opioids and gabapentinoids, patients with a numerical rating scale (NRS) pain score of 4 or higher, and patients with a total Hospital Anxiety and Depression Scale (HADS) score of less than 20. Patients with chemotherapy-induced peripheral neuropathy are excluded. The study will take place at 14 sites across Japan. Participants will be randomized (1:1 allocation ratio) to a duloxetine intervention group or a placebo control group. Evaluations will be made at baseline (T0 randomization), day 0 (T1), day 3 (T2), and day 10 (T3). The primary endpoint is defined as the difference in NRS score for pain intensity (average over the previous 24 hours) at T3 between the duloxetine and placebo groups. The enrolment started in July 2015. At the time of manuscript submission (November 2017), more than 95% of patients have participated. We thus expect to complete the recruitment by December 2017.

Discussion: Treatment of neuropathic pain in cancer patients represents an area of high unmet medical need. To our knowledge, there has been no randomised study of the analgesic efficacy of duloxetine in patients with neuropathic cancer pain refractory to opioids and gabapentinoids. This study of duloxetine in neuropathic pain refractory to opioids and gabapentinoids will be the first registered trial of therapy for this condition.

Biography:

Raymond Ng completed his MBBS at the age of 24 years from National University of Singapore and Masters of Medicine in Family Medicine from National University of Singapore in 2006. He also completed Advanced Specialist Training in Palliative Medicine in Singapore in 2012. He is a consultant in Palliative Medicine as well as Clinical Lead in Advance Care Planning in Tan Tock Seng Hospital.

Abstract:

Background. 

Since 2011, Tan Tock Seng Hospital has expanded its ACP programme to 15 clinical disciplines and home care programmes as well as trained at least 300 facilitators within the hospital. Despite continual efforts at improving course format based on post course feedback, only approximately 50% of facilitators go on to complete and document at least one ACP conversation post training. 

This study aims to explore attitudes, perceptions and practices of trained ACP facilitators in the hospital. 

Methods.

A qualitative approach informed by grounded theory was employed using semi structured individual interviews. Purposive sampling recruited facilitators of varying degrees of experience and different primary vocations. Each transcript was  independently coded by two research team members. The study team met for five sessions to discuss emerging themes and sub-themes.

Results.

25 trained ACP facilitators were interviewed. Not all facilitators were active and while most agree that ACP is important, practice depended on level of department and peer support, intrinsic belief of whether ACP is part of one’s job scope as well as self efficacy. Barriers include a lack of protected time to carry out ACP, traditional cultural taboos in talking about death and dying, lack of confidence, fear that the patient may perceive the medical team as “giving up” on him/her and language barriers in a multicultural society.

Active facilitators viewed establishment of rapport and the communication process as important rather than the completion of documents per se. There was a desire for better inter professional collaboration with close support by the primary medical team in the discussion, for ACP to be brought into civic conciousness in a co-ordinated way, and for a system incorporating ACP in routine care. Multiple core skills of the ACP facilitator were viewed as essential such as empathy, person centredness and advocacy, active listening, being a team player and self awareness.        

Conclusions.  

The professional identity and practice of a trained ACP facilitator can potentially be bolstered by strenghthening interprofessional collaboration, having a mentoring framework,  recognition of efforts, institutional support, raising public awareness as well as strengthening a community and culture of practice.

Biography:

Abstract:

Background: Palliative care is an approach that has been used to care for terminally ill patients. The current study was performed to assess the association between the status of patient dignity and quality of life (QOL) in Iranian terminally ill patients with cancer. Materials and Methods: This descriptive correlational study was conducted on 210 end‑stage cancer patients (102 men and 108 women) who were referred to Seyed Al‑Shohada Hospital, Isfahan, Iran, in 2015. To assess dignity status, we used the Patient Dignity Inventory. The Persian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire was used for QOL assessment. Results: There was a significant negative association between total dignity status and QOL scales. In addition, significant negative relationship was observed between dignity‑related domains (loss of worth sense: r = −0.50, P < 0.001; anxiety and uncertainty: r = −0.51, P < 0.001; symptom distress: r = −0.62, P < 0.001; and loss of autonomy: r = −0.61, P < 0.001) and functional scale and some subscales of the QOL scale. In contrast, a significant positive relationship was found between dignity‑related domains, and total symptom scale and fatigue. No significant relationship was observed between different items of dignity and global health status/QOL scale. Conclusions: High dignity status in terminally ill patients was associated with higher QOL in terms of functional intactness and lower symptom distress. Further studies are necessary to shed light to our findings.