Palliative Care: a Key Component of Care

1. Palliative Care: a Key Component of Care Liliana De Lima, MHA Executive Director International Association for Hospice and Palliative Care XVII International AIDS Conference Mexico City, August 2008

3. Components of Care • Prevention • Early Detection • Effective Treatment • Palliative Care

4. What is Palliative Care? An approach that improves the quality of life of patients and their families facing life-limiting illnesses, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” WHO, 2002

5. Principles of Palliative Care • Provides symptom control and pain treatment to improve the quality of life • Integrates psychosocial and spiritual aspects in the care plan • Offers support and help so that patients may have an active life as much as their condition allows them • Offers support and helps the family members during the disease management and progression • When and if death occurs, offers bereavement support

6. Provision of Health Care: Classical Model Therapists Psychologists Soc Workers Nurses Specialists Chaplain Friends Patient MD Family Nutritionists Caregivers Technicians Nurse aids

7. Palliative Care Model Nutritionists Pharmacists Psychologists Physicians FAMILY Therapists Chaplain PATIENT Nurses Social workers Technicians Nurses aids HC Worker

8. Who needs palliative care?

9. World Mortality 2001 • 56.5 million deaths worldwide • 76% in the developing regions, where over three-fourths of the population live • 33 million deaths non-communicable conditions (58%) • 18.3 million deaths communicable conditions (32.5%) • 5.1 million from unintentional and intentional injuries (9%) WHO, 2002

10. Global estimates for adults and children 2007 • People living with HIV:33 million[30 – 36] • New HIV infections in 2007:2.7 million [2.2 – 3.2] • Deaths due to AIDS in 2007: 2.0 million[1.8 – 2.3]

11. WHY Palliative care in hiv/aids?

12. Why Palliative Care in HIV/AIDS? • Pain and symptoms are experienced throughout the trajectory of the illness due to HIV, TB, and other related conditions • HAART is associated with significant side effects that need to be managed = increases adherence to treatment • Access to ARV is still limited to a small % of the PLWHA • As life expectancy increases with HAART, co-morbidities such as cancer, liver failure and cardiovascular diseases become prevalent • Patients, families and caregivers often require psycho-social and spiritual support

13. Symptom Prevalence in HIV/AIDS WHO, 2006

14. Integrated Model of Care for Chronic Conditions Curative Disease oriented Palliative Care Supportive-Symptom oriented Bereavement Diagnosis Death Disease Progression Person living with HIV/AIDS Family and Caregivers

15. Availability of and Access to Medications

16. Facts • In 2006, Western Europe and North America together accounted for 89 per cent of global consumption of morphine. • 80 per cent of the world population lives in developing countries and consumes only 6 % of the morphine distributed worldwide • More than 50 countries in the world still do not have any opioids available • Opioids are not available in rural areas and in home care in most of the countries in the world INCB, Press Release #4 p 11, March 2008

19. Opioids are Expensive • Comparative study • 15 analgesic therapies, 12 countries • Monthly Morphine ED • 3 street pharmacies • Number of therapies >33% than the monthly GNP per capita: • 4% in developed countries • 51% in developing countries De Lima L, Sweeney C, Palmer JL, Bruera E. JPPCP Vol 3 (2), 2004

20. Education

21. Education in PM: Survey All medical schools in Canada (16); UK (30), and 129 randomly selected in the USA and Western Europe Oneschuk, Hanson, Bruera - An International Survey of Undergraduate Medical Education in Palliative Medicine JPSM, 2000

23. Palliative Care in Health Policy

24. HEALTH POLICY Financing and Organization Morbidity and mortality, socioeconomic and health needs • Structural Indicators • Process Indicators • Outcome Indicators TOP DOWN Palliative Care is developed, implemented and provided as a result of Policy BOTTOM UP Policy is created by influence and demand at the grass root level

26. Palliative Care in HIV/AIDS in LAC • Survey through the ALCP listserv, seminars and direct contacts • 290 responses from 18 different countries • Countries with a rate of > 8% were included • Argentina, Brazil, Chile, Colombia, Mexico y Venezuela • Final sample size: 250

27. Palliative Care in HIV in LA • 86% National Programs on HIV/AIDS in MOH • 95% of the HIV/AIDS care is offered through public system • 92% Include prevention • 98% include ARVs • None have PC in public programs – only a few NGOs and private insurance programs (37%) • Pall care is paid by charities, (78%), out of pocket (61%) and insurance (50%) Wenk, De Lima 2006

28. A moral imperative:Joint Declaration and Statement of Commitment • Coordinated by the International Association for Hospice and Palliative Care (IAHPC) and the Worldwide Palliative Care Alliance (WPCA) • More than 50 representatives of international, regional and national organizations from the field of Palliative Care, Pain, Cancer, HIV/AIDS, Psychiatry and Neurology • Individuals • Aim is to work on 7 areas: Recognition of palliative care and pain treatment as human rights, ensuring access to palliative care services, education, and eliminating barriers in opioids for pain treatment. • Signatures collected until World Hospice and Palliative Care Day – Oct 11 • To sign: • IAHPC: www.hospicecare.com • WPCA: www.wwpca.net • World Hospice Palliative Care Day: www.worldday.org