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Name
Editor
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Profession
Question
Dr. McKeown thank you for joining us today for our live dialogue
Can you please start by telling us what palliative medicine is? Tell us a little about what you do.
Answer
Salam everyone and thank you for the opportunity to be here with you today. Palliative medicine is the care of people who have advanced incurable illness, most often cancer. It is care that includes physical, emotional, spiritual and social support for the patient and the patient's family. This sort of care is provided by a group or team of people including a doctor, nurses, psychologists, social workers, counselors, physiotherapists, occupational therapists and spiritual advisors. Patients can be cared for in hospital or in a hospice or in their own home depending on the needs of the patient and the family.
The goal of palliative care is not to cure but to provide comfort during the last part of life in what ever way possible. Sometimes this is referred to as "improving quality of life". The people that I help to take care of are not dying, rather they are living the last part of their life. It is the job of the palliative care team to help to make living as pleasant and meaningful as possible.
I have been working in palliative care for more than 10 years in Australia and have looked after people in their homes, in hospitals, in hospices and sometimes even in the desert and the forest! The team goes where the people are!!
Name
Allison
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Profession
Question
Dr. McKeown why is palliative medicine important to a cancer patient? What will happen if they don't use it?
Answer
Palliative medicine can be helpful to a cancer patient at any point in their illness if there are symptoms or issues that the patient needs support or help with. However we usually find that patients are referred late in their illness after maximal treatment has been undertaken. Generally we find that these people have had a long course of treatment with little attention paid to their quality of life because care has been focused on cure. When cure is no longer possible we have a new opportunity to reexamine what makes life meaningful and to work on improving quality of life. In the first instance this will mean managing symptoms related to the cancer. When symptoms are controlled there is an opportunity to focus on other quality of life issues such as where does the person wish to be cared for, what do they need to do with their time, how can we support their family, how does the person's spiritual belief system support them, do they need emotional support - in essence all of these possibilities will be guided by what the person and their family tells us that they want. Sometimes the person wants something very simple, for example to visit a friend, to sit in the garden, to reaffirm their spiritual beliefs. At other times it can be much more complex, for example the person who wants to die at home in the desert, camping on the land they were born in, 500km from the nearest medical help.
If people do not have the opportunity to access palliative care they are often denied the opportunity to have good symptom control, to choose where they want to be cared for, their families are unprepared for the person's inevitable death and opportunities to resolve existential issues are missed. Worst of all, families miss the opportunity to spend good time together and make good memories of the last part of the person's life.
Name
Samira
- Morocco
Profession
Question
I don't understand what exactly palliative medicine is. Is it available in all countries?
Answer
I have outlined what palliative medicine is in my first answer.
Palliative medicine is a relatively new specialty and has only been officially recognized in this country (Australia) last year. Many countries have limited resources to fund basic healthcare and therefore palliative care is seen as a luxury or an optional extra. The foundations of modern palliative care came out of the UK in the early 1970s. New programs are being developed to support people with incurable illness in many countries, for example Ethiopia is starting a palliative medicine program to care for patients in Addis Ababa who have late stage AIDS infection. Insha Allah, in time more people will have access to the type of end of life care palliative medicine can provide.
Name
Wild_Rose
- Palestine
Profession
High school student
Question
Dear Dr. Joanne:
In your profession you try to reduce the pain of cancer patients. I just wanted to ask you; during your work have you notice that reducing the pain helps to reduce the spiritual damage which many cancer patients have?
Answer
Thank you for your question.
There is no doubt that pain will prevent people from concentrating, thinking clearly, praying and communicating with those around them. If pain is constant it is all consuming and uses all the person's energy. It is only when pain is controlled that people can use their energy to consider spiritual issues and to work on exploring their faith and belief system. This can be a very important area for people to explore at the time of their life when death is most imminent and I have seen many examples of healing and acceptance when people are free of pain and able to concentrate.
Name
KevinB
- Australia
Profession
Question
I have heard several cases around the world of medical staff, at the request of the patients, giving them doses of drugs that would kill them. What is your opinion about that?
Answer
Palliative medicine does not include killing of patients under any circumstances. To do so is illegal in most countries. Most requests from patients for euthanasia come from a basis of poor symptom control or from psychiatric conditions such as depression. The correct response to these requests is to explore the reasons behind the request and identify the issues that need to be addressed to help to make the person's life more livable.
On my last weekend on call a patient gave me a note asking for medicine to kill them. When I discussed the reasons for this with this lady I discovered that she was frightened of never getting out of hospital, she was isolated from her family, she had poorly controlled pain as she did not have sufficient English to explain her problems and she was frightened that it would all inevitably get worse. It was possible to talk about these issues with her and make a plan including her and her family to address these problems. This week she is planning to go out of the hospital with her family for two days on the weekend, she is smiling again and she has new energy to live the remainder of her life.
In clinical experience I have come across situations where doctors have felt under pressure to kill patients to relieve the patient's suffering. Doctors who agree to do that are often isolated practitioners, unsupported by other members of the care team and untrained in what else is possible.
Name
Marwa
- Egypt
Profession
Question
Would you suggest something natural to overcome cancer pain?
Answer
Unfortunately cancer pain is often very complex and responds poorly to natural therapies. However bear in mind that morphine is a natural product that comes from the seed of the poppy flower. Morphine type medication can definitely be of assistance in reducing cancer pain.
Name
Amir
- Malaysia
Profession
Question
From what I heard, radiotherapy and chemotherapy in cancer patients can be very painful and the elderly sometimes can't survive them, what is the role of palliative medicine in this situation?
Answer
Many elderly patients decide to forgo any chemotherapy or radiotherapy when the side effects of the treatment outweigh the possible benefits. This is a legitimate choice. Under these circumstances palliative medicine can offer the same symptom control and emotional, spiritual and social support that I have outlined earlier. Palliative care teams often look after these patients and work hard to improve their quality of life.
Name
Unbreakable
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Profession
Question
Do palliative techniques different according to patient age, gender etc?
Answer
Thank you for the question.
The principles of palliative care are the same for all patients regardless of the patients' age or gender or type of cancer. The specifics of palliative care will vary from patient to patient based on the patient's individual needs. A detailed assessment is required to identify each patient's problems and goals and management is targeted at these specific issues.
Name
Hadeer
- Qatar
Profession
Question
Are there cases when palliative disease is not recommended for cancer patients anymore?
Answer
Palliative care has something to offer any person with cancer, particularly when the cancer cannot be cured. The focus on each person's individual needs means that a palliative care management plan can be formulated to address the needs of individual patients regardless of the type of incurable cancer they have.
Name
Olza
- Egypt
Profession
Question
Can you give me advice how I can work in my community to reduce the pains of cancer patients?
I'm sure everyone is surrounded with cancer patients in this age, how can I help, even if a little bit, to make it easier on them?
Answer
Palliative care teams often include volunteers who work with patients and families to support them in their day to day lives. This may include helping with shopping, cooking, child care or even just sitting with the patient to give the carer a break. These programs are often run through local hospitals and I would encourage you to contact your nearest hospital or healthcare facility to ask them what opportunities they have for volunteers to assist patients.
Name
Abdullah
- Saudi Arabia
Profession
Question
I wanted to ask about the side effects of palliative medicine, how severe can they be?
Answer
Like all types of medicine, palliative care aims to minimize side effects of treatment. The aim is to improve quality of life and no treatment would be started without considering its risks and benefits. Usually we do not prescribe any medication unless there is good evidence that the medication will do more good than harm. Treatment is also regularly reviewed to ensure that it is achieving the goal of improving quality of life.
Name
Kristina
- Russian Federation
Profession
Question
I understand that morphine shots and other strong drugs are part of palliative medicine, are there steps to ensure the patients don't addict these drugs?
Answer
Thank you for your question.
In cases where patients have severe pain as a result of incurable cancer patients do not become addicted. Doses of morphine are started at low levels and increased according to the level of pain the patient has. There is no evidence that patients who have cancer pain will take extra pain medicine for enjoyment only. I have not seen any cases of addiction in my work over the last ten years. Patients understand why they need the medication and how it will be provided so there is little possibility of drug abuse under these circumstances.
Name
Sonita
- India
Profession
Question
Is palliative medicine a changing science like other branches of medicine? Are there new techniques coming up for palliative medicine?
Answer
Yes! Every day there are new medications to use for relief of symptoms, new evidence for the best management of various problems and more information about the range and type of problems people face.
This is one reason why palliative medicine is such an interesting and dynamic area to work in. Every day I learn new things from each patient - about how to best communicate, how to best support families, how to work together to make the end of life as productive and comfortable as possible. Research is also going on into many areas of palliative medicine to look for evidence and develop best practice guidelines.
Name
Laura
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Profession
Question
Cancer treatment usually involves radiotherapy or chemotherapy that can in itself be extremely difficult on the patient. What kind of a role does the palliative care doctor play in minimizing the negative effects of chemotherapy, for example?
Answer
Thank you for your question.
Palliative care teams are often involved in the care of patients who are still receiving active treatment. In these cases we will talk with the patient and family about what their main concerns are. Often these will be physical symptoms such as nausea, sore mouth, yeast infection, bowel problems etc.
The team will work out a plan to treat these problems to help the patient to cope with the ongoing treatment. This can range from simple medication strategies for nausea and sore mouth, to anxiety management for treatment of disease related anxiety to spiritual counseling if spiritual distress is a concern. This is one of the most rewarding areas of palliative care because it is often very simple to address the treatment related side effects and this supports the patient during their treatment when otherwise they may have no option but to discontinue treatment due to side effects.
