Day 1 :
Keynote Forum
Trisha Dunning Am
Deakin University, Australia
Keynote: Developing guidelines to manage diabetes during palliative and end of life care: a collaborative iterative approach
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Biography:
Professor Dunning is the inaugural Chair in Nursing and a member of the Centre for Quality and Patient Safety Research in the Barwon Health Deakin University Partnership. Her research and care focus in on older people with diabetes and diabetes and end of life care. She is widely published in these areas. She serves on many professional committees and advisory boards, including Diabetes Victoria, College of Nursing Australia and the International Diabetes Federation She was made a Member of the Order of Australia in 2004 for her work in nursing and diabetes.
Abstract:
Diabetes is an underlying cause of death in over 60% of deaths due to diabetes complications and other comorbidities. People with diabetes have a shorter life expectancy than the population. Quality diabetes palliative and end of life care requires a personalized approach and should be a proactive collaborative endeavor. Clinicians are reluctant to discuss these issues with people with diabetes and there is limited guidance to support their decision-making.
Keynote Forum
S. Irudaya Rajan
Centre for Development Studies, India
Keynote: Palliative care for the Elderly in India
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Biography:
S. Irudaya Rajan has completed his PhD at the age of 30 years from International Institute for Population Sciences, Bombay. He is Professor at Centre for Development Studies, Kerala, India. He has published extensively in national and international journals on social, economic, health and demographic facets of aging since the last three decades. He conducted the first longitudinal Aging Survey in Kerala in 2004, which is repeated every three years, and entered its fifth wave in 2016. He has been involved in several projects on aging funded by the United Nations, South Asian Network of Economic Institutes, Indo-Dutch Program on Alternatives in Development, Shastri Indo-Canadian Institute, International Development Research Centre, World Bank and Help Age International.
Abstract:
India’s elderly population stands at 123 million in 2018. According to the 2014 round of the National Sample Survey, two million elderly persons in India are bedridden and another seven million are confined within their households. Who will take care of them during their sunset years? The issue of caring for the elderly, and ensuring their dignity at death, should thus receive immediate public attention. In this context, this paper is an attempt to understand the steps taken by government and other agencies in India to cater to the care needs of the elderly. It further looks at the flaws in these mechanisms and offers some suggestions to improve the present situation. We shall use government reports, organisations working in the field of palliative care and Kerala Aging Survey data. Palliative care for elderly in India is still in the early stage of development. Many elderly are not aware of the existing policies on palliative care. Awareness programmes, care training centres, etc. are need of the hour. Though we have multiple mechanisms in the area of palliative care for the elderly, there are many loopholes here which have to be addressed.
Keynote Forum
Maditobane Robert Lekganyane
University of South Africa, South Africa
Keynote: The relationship dynamics of palliative care between home-based caregivers and their patients: a South African study of home-based care
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Biography:
Dr Lekganyane is an emerging researcher. He completed his Bachelor’s degree in social work at the age of 25 from the Univrsity of South Africa. In 2009 he completed his Masters in Social behaviour studies in HIV focusing on HIV and AIDS-related stigma and later on in 2017 he completed his PhD in Social work where he lookded into the experiences and challenges faced by home-based caregivers caring for people living with HIV and AIDS. Dr Lekganyane wokered for the Non-governmental organisations in South africa and for various government departments. He is currently a Senior lecturer in the department of social work at the University of South Africa. In his academic career, Dr Lekganyane published two articles in the fields of HIV and AIDS and palliative home-based care.
Abstract:
The nature of relationship that palliative caregivers have with their patients is a very personal experience requiring sustained effort from both the caregiver and the patient to enhance this relationship. Whereas the former allow the latter into their private lives to care for and support them, the latter expect patients to cut-off certain behaviours and lifestyles, which may aggravate their conditions. The overall aim in this process is to help the patients to recover from their condition and develop strength enough to care for themselves and fend for their loved ones. With the dearth of research-based literature around the nature of relationship, palliative caregivers have with their patients, qualitative research, which was guided by descriptive, contextual and phenomenological research designs, was conducted in South Africa to uncover the dynamics involved in the relationship between the caregivers and their patients during the caregiving process. Twenty-five palliative caregivers who were sampled through purposeful and snowball sampling responded to the semi-structured interviews, which were later analysed. Frustrations were found to be common among caregivers as triggered by patients with mood swings, some of whom lacked hope, abuse substances and non-compliant to treatment. Some male and older patients who respectively refused to be cared by young and female caregivers further exacerbated this relationship, making it more hostile. Suggestions for programs aiming to support caregivers to enhance their relationship with patients to be developed and integrated into palliative care programs.
Keynote Forum
Michaela Bercovitch
Sheba Medical Center, Israel
Keynote: Hospice - The Right to Choose
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Biography:
Abstract:
Since ancient times, the obligation of the physician was to relieve suffering. Despite this fact, little attention was given to the problem of suffering and dying in medical education, research or practice. In the 21st Century life expectancy is increasing, more people live with serious effects of chronic illnesses, and they must deal with many complex issues: relief of symptoms, effect of the illness on roles and relationships, restoring or maintaining quality of life. Each of these issues creates expectations, needs, hopes and fears, which must be addressed in order for the ill person to adapt and continue living, and presents a set of public health challenges requiring the attention of policy makers.Traditionally end of life care in the form of Palliative care has been offered mostly to cancer patients. For some years this kind of care has been offered for a wider range of serious illnesses, and was integrated more broadly across care services.Hospice was created as "a coordinated program providing palliative care to terminally ill patients and supportive services to patients, families, 24 hours a day seven days a week. Services are comprehensive, case managed based on physical ,social , spiritual and emotional needs during the dying process by medically directed interdisciplinary team consisting of patients, families, health care professionals and volunteers"(WHO).Hospice treatment is the most personalized way to care, by recognizing a patient not only like a body part, but as a unique being, with soul and psyche. Each patient means a new book to be read and understood by the team.Accordingly, Hospice care is flexible, and aggressive palliative interventions have to answer some questions: what is the goal of intervention?, does the intervention has a chance of high efficacy?, what is the impact on the patient (side effects, complications, discomfort)? what is the life expectancy?, and what does the patient want? Hospice program is limited for those patients diagnosed with terminal illness with a limited life spam and it is not a must in health care system. Hospice is a choice and any individual has the right, in conformity with the law, to decide how to be treated when facing a terminal illness. Those patients refusing to accept the imminence of death and want to continue to fight they are not eligible for hospice. Those prefer to concentrate on living as comfortably as they can until their last day prefer the hospice care.
- Pediatric Palliative care
Location: Melbourne, Australia
Session Introduction
Sven Jennessen
Humboldt Universität Berlin, Germany
Title: Quality Advancement of Children's and Youth Hospice Work in Germany with QuinKÂ
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.
- Palliative care and Spiritual care
Location: Melbourne, Australia
Session Introduction
Pushparanee Somasundram
Sengkang General Hospital, Singapore
Title: Diverse end of life cultural practices in Singapore
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”.
- Palliative Care in Pain Management
Location: Melbourne, Australia
Session Introduction
Olfat Zekry
The University of Sydney, Australia
Title: Hydromorphone induced neurotoxicity in palliative care
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.
Thomas Thaniyath
University of Tabuk, Saudi Arabia
Title: Effective analgesia for good quality of death- A non- Pharmacological approach
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
- Palliative care in Oncology
Location: Melbourne, Australia
Session Introduction
Divya T
Department of Nursing, Cancer Institute, Chennai
Title: An Analysis of referral pattern of cancer clients to palliative care clinic – A retrospective report
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