Day 2 :
Keynote Forum
Michael Ian Rothenberg
The Center for Counseling and Sexual Health, Florida
Keynote: Understanding Sex and Sexuality in Palliative Care; Establishing a Dialogue at the End of Life
Time : .
Biography:
Michael Ian Rothenberg, Ph.D, LCSW is a Board Certified Clinical Sexologist, Certified Sex Therapist, Psychotherapist and the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park, Florida. As a sexuality educator, Dr. Rothenberg has held a long term faculty position, in Orlando, Florida, at the University of Central Florida (UCF), School of Social Work, where he developed the curriculum in Human Sexuality and taught courses on human sexuality and sexual behavior. Dr. Rothenberg, a former Hospice Social Worker, credited with developing the Sexological sub-field of Thanatological Clinical Sexology (the study of sexuality, death and dying), has published and been quoted in numerous articles relating to human sexuality and lectures, both nationally and internationally, at universities, hospitals and hospices, on topics related to human sexuality, sexual behavior and sexual health.
Abstract:
Introduction: Human beings are sexual beings from birth until death. This presentation explores sex and sexuality at the end of life and the importance of establishing a dialogue between patients and clinicians as an integral part of end of life care. Objectives: To identify and understand barriers and challenges in discussing sex and sexuality at the end of life and establish a methodology for better communication.Methods: A qualitative methodological approach was utilized and the resultant data will be presented as case histories gathered in the context of clinical sexology consultations.Results: As discomfort and physical pain, at the end of life, can be controlled through the proper use of medication, psychological and emotional distress, directly and indirectly, related to sex and sexuality, can be ameliorated through specific conversation and dialogue. Conclusion: This presentation hopes to raise important questions about the palliative care professional's responsibility regarding the understanding of sexuality for individuals in the end of life stage as well as illustrate how to begin to engage in needed discussions on sex and sexuality.
Keynote Forum
Mellar P Davis
Geisinger Medical Center, United States
Keynote: What is the Evidence for Early Integration of Palliative Care into the Management of Serious Illness?
Biography:
Dr. Mellar P. Davis, MD, FCCP FAAHPM is a member of the Palliative Care Department, and Section Head, Geisinger Medical System Danville, PA. He has been a member of the Geisinger Medical Staff since August 2016. In his role as Section Head, Dr Davis is responsible for developing palliative care services throughout the Geisinger Medical System including outpatient and inpatient services. In addition, Dr Davis works with the Geisinger Hospice Services to develop and coordinate care within the central region.
Abstract:
Palliative care has emerged as an approach that specifically addresses gaps inherent in a disease-centered approach to care. Early palliative care has been promoted as the optimal approach to care for individuals with advanced illnesses. A systematic review of trials found 15 RCTs (randomized controlled trials) of early outpatient, 13 RCTs of home palliative care and 7 systematic reviews(1). A subset of RCTs have demonstrated improved symptoms, quality of life, reduced aggressive care at the end of life, increased advanced directives, reduced hospital stays, improved caregiver burden and quality of life, reduced costs and improved family satisfaction. Yet RCT have also demonstrated no benefits to palliative care in the same outcomes. Why the difference? The term “early” and “standard of care” are poorly defined and subject to regional practices. Imbalances and attrition between groups contributed to differences in outcomes. Many RCTs lacked power calculations or were under powered for outcome measures. Outcomes were skewed yet parametric statistics were done giving weight to outliers in the results. Timing of assessment for outcomes in some trials was too early or late to see full benefits. Intention to treat analysis was often not done; outcomes were based on treatment analysis. Financial assessment was based exclusively on costs or charges centered on medical resource utilization rather than family expenditures. Multiple models of palliative care were used in these RCTs. This workshop/concurrent session will review the evidence for early palliative care and the differences and weaknesses in trials which may have contributed to divergent outcomes.
Keynote Forum
Heike Baranzke
College of Philosophy and Theology, Germany
Keynote: Reset the "sanctity of human life “debate. Consequences regarding hospice and palliative care
Biography:
Dr Baranzke is a theological ethicist and often engaged in interdisciplinary research groups. In her ethical research she questions central, mostly traditional ethical terms (sanctity of life, dignity, reverence for life, person etc.) in life science ethical debates in the light of the concepts’ history in order to deconstruct misunderstandings in present human and non-human bioethical debates. At present she is a member of a research group in nursing ethics.
Abstract:
For about five decades the phrase “sanctity-of-life“ has been part of the Anglo-American biomedical ethical discussion especially about abortion and euthanasia. Nevertheless, the concept’s origin and meaning are unclear. Much controversy assumes that the concept denotes the absolute value of human life and thus dictates a strict prohibition on euthanasia and physician-assisted suicide. Therefore, the well-known bioethicists Peter Singer and Helga Kuhse have proclaimed the necessity to replace the traditional ethics of the sanctity of human life-doctrine by a new ethics. They have stimulated a vivid sanctity vs. quality of life-debate.
In 2012, I have offered an analysis of the religious and philosophical history of the idea of “sanctity-of-life.” Drawing on biblical texts and interpretations as well as on Kant’s secularization of the concept, I have argued that “sanctity” has been misunderstood as an ontological feature of biological human life. Instead, I have traced back the term to the virtue-ethical tradition in ancient and medieval times, which conceives sanctification as a personal achievement through one’s own actions. On this basis a fresh start can be taken by asking, which consequences this kind of conception of the term may have with regard to hospice and palliative care in comparison to the utilitarian approaches of Singer and Kuhse.
- Palliative care in Geriatrics
Location: Melbourne, Australia
Session Introduction
Urmi Chavan
Sheffield Hallam University, United Kingdom
Title: Physiotherapy in dementia
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:
We live in a maturing world, and that is closely associated with conditions, such as, osteoarthritis, osteoporosis, cataracts, stroke, growth, coronary supply route illness and dementia, which increasingly affect the group wellbeing (Guccione, 2011) Of these conditions, dementia emerges as the one to inspire dread in those contemplating over a solid seniority. "Dementia" is principally a term used to portray a gathering of manifestations that might be brought on by various distinctive ailments. This incorporates Alzheimer's infection, vascular dementia, frontal temporal dementia and dementia with Lewy bodies (Curran, 2004). Aim: To develop an understanding of the role of physiotherapy in dementia in current practice, the identifyable short-comings of the current services provided, and approaches that can be used to tackle the identified problems.The worldwide predominance of dementia is prone to be as high as 24 million, and is anticipated to double at regular intervals through to 2040, resulting to a costly burden of disease (Reitz et al, 2011).As a physiotherapist targets a variety of structural as well as psychological deficits in demented patients and provides treatment for the same, the significance of interaction plays a vital role in building up a therapeutic relationship, leading to successful assessment and treatment (Orange et al, 1998). The key, therefore, as a physiotherapist is to adapt communication strategies unique to patients with dementia in clinical practice.Conclusion: Physiotherapy is a significant factor in rehabilitation of patients with dementia and must adapt a holistic approach during assessment and treatment, taking into consideration all the factors affecting patient centered ca.
- Pediatric Palliative care
Location: Melbourne, Australia
Session Introduction
Beaven Andrew A. Atienza
Mindanao State University- Iligan Institute of Technology, Philippines
Title: Palliative Care for Children with Cognitive Disabilities and their Caregivers Challenges
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.
- Palliative Care and End of life Care
Location: Melbourne, Australia
Session Introduction
Wahyu Dewi S
Wiyata Husada Nursing School, Indonesia
Title: The Perspective of Good Death among Advanced Cancer Patient under Indonesian Culture
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.
- Hospice and Palliative Care
Location: Melbourne, Australia
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.
Hamza Ettahri
National Institute of Oncology, Morocco
Title: Palliative Care, A Reel Challenge in Income and Middle Countries. Example of Morocco
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
- Poster Presentations
Location: Melbourne, Australia
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.
Raymond Ng
Tan Tock Seng Hospital, Singapore
Title: An exploratory study of attitudes, perceptions and practices of trained facilitators in advance care planning in a tertiary hospital in Singapore
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,
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.
- Video Presentation
Location: Melbourne, Australia
Session Introduction
Masoud Rezaei
Katana Hospital, Iran
Title: The Relationship between Dignity Status and Quality of Life in Iranian Terminally Ill Patients with Cancer
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.