1. PALLIATIVE CARE CASE STUDY Qamar Abbas Deputy Medical Director St Clare Hospice

2. PALLIATIVE CARE PROBLEM 49 years old patient Sarah admitted with history of Breast cancer with chest wall extension and lung metastasis for pain management. She has pain in arms, and chest wall Lives alone, divorced, three children age 17, 14 and 4. drug addiction history Very withdrawn Angry with nurses and doctors When medications prescribed, refused medications most times.

3. PALLIATIVE MEDICINE An approach which improves QUALITY OF LIFE of PATIENTS and their FAMILIES facing LIFE-THREATENING ILLNESS through prevention and RELIEF OF SUFFERING by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Cancer pain relief and palliative care. Geneva; World Health Organization: 2002

5. PHYSICAL ISSUES Pain Opioid side-effects Breast wall infiltration Lymphoedema

6. TOTAL PAIN “It began in my back, now it seems that all of me is wrong. I began to cry for the pills and injections but I knew that I mustn’t. The whole world seemed to be against me. Nobody seemed to understand. My husband and son were marvellous, but they were having to stay off work and lose their money. It’s marvellous to begin to feel safe again.”

7. SOCIAL ISSUES Lives alone: care issues Financial issues Child care issues

8. PSYCHOLOGICAL ISSUES Withdrawn Depression Loneliness Helplessness

9. EMOTIONAL ISSUES Divorced Unloved Fear for children Unable to express love so that they do not get too close and hurt

10. SPIRITUAL ISSUES Why me? If I do not take pills, it will speed it up… Can you give me something? I will not tell anybody…..

11. PALLIATIVE CARE

12. CHALLENGES Clinical Knowledge of diseases and their progress Symptom Management Communication skills (listening) Ethical dilemmas Patient empowerment Staff issues: Self-knowledge, Team membership, Reflection Personal issues: Empathy, Patience, Courage