Palliative Care in

Bangladesh
GROUP : I
Introduction to Palliative Care
 Objectives

• At the end of this module, learners will be

able to
• Define palliative care
• Describe the goal and key principles
of palliative care
• Recognize the sufferings
• Describe the ways of providing
Palliative Care
• Explain the trajectories of illnesses
• Introduce the organizations where
palliative n care services are available
WHO define palliative care, 2002

• Palliative care is an approach that improves the quality of

life of patients and their families facing the problems
associated with life-threatening illness through the
prevention and relief of suffering by means of the early
identification, impeccable assessment and treatment of pain
and other problems, physical, psychosocial and spiritual.
 International Association for Hospice and
Defining Palliative Care (2018):

Palliative Care

The active holistic care

of individuals across all
ages
Palliative With serious health-
care is: related suffering due to
severe illness
Especially of those near
the end of life.
Key Features of Palliative Care:
• Prevention, early identification, comprehensive assessment and
management of symptoms

• Palliative care is delivered while respecting cultural values and beliefs

• Facilitates effective communication, helping patients and their families

determine goals of care*
 • To improve the quality of
life of patients, their
Goal of
families and their
Palliative
caregivers.
Care
 When to give Palliative Care?
• Many people think about Palliative Care as care when someone has only
days or weeks to live
• But, Palliative Care can be provided for months or even years
• It does not hasten death, but improves the quality of life for our patients
• It can be provided at the same time as disease modifying therapies (such
as chemotherapy)
The World Health Organization
recommends

beginning Palliative Care when

a patient is diagnosed with a
life-threatening condition
What does the research show about early
integration of palliative care?
• Integrating palliative care early in a serious illness results in:
• Less time in hospital

• Fewer emergency department visits

• Less intensive treatment at end of life

• Improved quality of life and symptom management

• More likely to die at home

• Reduced family caregiver stress and burden

10
Goals of Care:

Prolong a Optimize
Health life of comfort
Care Cure
Team’s
good at the
Goal: quality end of life

Patient’ Live as long as Live as long as Live as

s Goal: possible possible while comfortably as
being possible
comfortable
What are components of serious health-
related sufferings?
• Those with a chronic or life-threatening illness may have:
• Physical concerns: Pain and other symptoms

• Psychological distress: Sadness, anger, worry, anxiety, etc.

• Spiritual distress: Religious concerns, broader search for meaning in life

• Social needs: Basic needs for food, shelter, money

Examples of Suffering: Pain, Dyspnea, and Worry
What do people want when they have an
incurable illness?
• Pain and symptoms controlled
• Achieve a sense of control, through clear communication
• Relieve burdens on family
• Strengthen relationships with loved ones
• Avoid inappropriate prolongation of the dying process
Models of how to provide
palliative care
Model of Palliative Care
Locations where palliative care should be
available
• Community or Home
• Community-based palliative care teams visit patients at home
• Hospices
• Specialized health facilities where patients can come to receive palliative
care, generally focussed on end of life care
• Hospitals
• Specialist palliative care teams
• Inpatient facilities
• Outpatient departments
• Clinics and other health facilities
• Outpatient departments
Types of Palliative Care Provision
• Palliative Care can be provided by all health care providers in any
setting

• Health care providers who see more seriously ill patients need
more advanced palliative care skills
• Complex cases  refer to a specialist palliative care team
 General Palliative
Care

Palliative Care
Approach
Trajectories of Illness
• Life Limiting Illnesses:
• Advanced Cancer

• Trajectory: Typically short

(months) with predictable
decline
• Cancer has the most
predictable trajectory
Clinical Example: 51 year old Noor
• Advanced lung cancer, which has spread
• Her oncologist but prescribes chemotherapy, but
doesn’t tell her that this is not going to cure her
• Noor develops severe vomiting is admitted to hospital
• She regrets starting chemotherapy, and decides to go home and
receive palliative care
• Palliative care team provides medications to help with her pain
and breathlessness
• She dies at home 3 months later, cared for by her family with the
support of the home palliative care team
Chronic Diseases with progressive
decline (organ failure):
• Cardiovascular disease, Chronic lung
disease, Renal failure, Chronic liver failure

Trajectory: slow deterioration with

intermittent serious episodes
-During serious episodes, often require
admission to hospital and/or intensive
treatment
-More difficult to predict which serious
episode will lead to death
 Clinical Example: 65 year old Rita
• Advanced renal failure
• She is cared for at home by husband and
in dialysis unit.
• Her treatment included high dose
diuretics and regular dialysis. She
requires frequent blood tests.​
• She has had 5 hospitalizations for renal
failure and infection in the past
• She dies in hospital from severe infection
Medical Fragility and Frailty:
• Dementia
• Multi-organ failure (eg. heart
failure, with chronic kidney
disease and diabetes)
Trajectory: prolonged dwindling
-starting from low baseline of
cognitive or physical functioning
-may die suddenly from acute
event, eg. pneumonia, hip fracture
 Clinical Example: 92 year old Lubna
• Widowed and lives alone
• Chronic kidney disease and severe
COPD
• Arthritis and physical frailty
• Does not leave her home due to
fear of falling
• Neighbors bring her food
• She has weekly visits from
community palliative care worker
who notices a gradual decline in
her condition
Palliative Care is available in many countries around the world,
but in some places (red and orange) it is very limited
The need for palliative care in Bangladesh
• There are an estimated 6 00 000 patients in Bangladesh who need
palliative care each year
• 2 00 000 patients diagnosed with cancer annually
• 80-90% of cancer patients are incurable at the time of diagnosis
Organizations where Palliative care services
are avialable
Specialist Palliative Services are available at the following locations:

• Bangabandhu Sheikh Mujib Medical University (BSMMU)

• Dhaka Medical College Hospital (DMCH)
• National Institute of Cancer Research & Hospital (NICRH)
• Ashic Foundation (pediatric patients only)
• Hospice Bangladesh
• Delta Hospital
• Fasiuddin Khan Research Foundation
• Bangladesh Palliative and Supportive Care Foundation
 Dept of Palliative Medicine - BSMMU
Facilities include:
1. Inpatient
2. Outpatient
3. Pediatric Inpatient and OPD
4. Home Care
5. 24/7 Telephone consultation
6. Lymphoedema clinic
7. Community-based Project in Korail Slum

Key Contact: Prof. Nezamuddin Ahmad

 Dhaka Medical College Hospital
Facilities include:
1. Inpatient Palliative Care Unit
2. Outpatient Consultations

Key Contact: Dr. Jameela Khan

National Institute of Cancer Research &
Hospital
Facilities include:
1. Inpatient Beds
2. Pain & Palliative Care Clinic

Key Contact: Dr. Lubna Marium

 Private Organizations - ASHIC Foundation
Facilities include:
1. Pediatric Inpatient Unit
2. Pediatric Outpatient Consultation

Key Contact: Dr. Momena Begum

 Private Organization: Hospice Bangladesh

Facilities include:
1. 24 hour Home Care (in Dhaka)
2. OPD
3. Free home care service for poor patients
4. 24 Hour telephone service

Key Contact: Dr. Shahinur Kabir

 Private Organization: Delta Hospital

Facilities include:
1. Inpatient
2. OPD

Key Contact: Dr. Nazmul Kabir

 Bangladesh Palliative Care and
Supportive Care Foundation
Facilities include:
1. Inpatient
2. OPD

Key Contact: Dr. Rumana Dowla

Resource Persons in Palliative Care

Nurses: Rowsan Ara

Lailatul Ferdous Zobaida Khatun
Farhana Aktar
Prof. Dr. Nezamuddin Ahmed
Dr. Rumana Dowla Dr. Zohora Jamela Khan
Dr. Farzana Khan Dr. Megan Doherthy
Dr. Lubna Marium
Dr. Shahinur Kabir