Developing the section of palliative care at St Paul's Hospital Iloilo

Developing the
Section of Palliative Care
at St Paul’s s Hospital Iloilo,
Philippines
Dr. Jesus Eugenio G. de Jesus
Consultant, Dept of Family Medicine
St. Paul’s s Hospital
Iloilo City, Philippines

Project Background
• Cancer
– 3 rd most frequent
disease in the
Philippines
– 70% of Filipino cancer
patients are deemed
incurable upon time of
diagnosis
– comprises 10% of
deaths in the
Philippines and at St.
Paul’s s Hospital Iloilo

St. Paul’s s Hospital Iloilo
• A hospital that is
Christ-centered,
dynamic, committed
to providing holistic
quality health care
• To be the first
Catholic medical
facility in Western
Visayas to propagate
palliative care

SPH Palliative Care Section
General Objectives:
• To elevate the quality of life of terminally
ill cancer patients
• To allay the concerns of the family as to
the patient’s s end-of
of-life care
• To coordinate with other services
providing continuing care for patients
and their families

SPH Palliative Care Section
Services:
• Access to medical experts
• Counseling with regards to issues of death,
dying and bereavement
• Assistance to families in arranging home care
• Spiritual care for the patient and family
• Coordination with home care teams
• Continuing education for health care
professionals in caring for terminally ill patients

SPH Palliative Care Section
The Clients:
• Terminally ill
patients and their
families
• Concerned
individuals
The Team:
• Family Medicine
resident physicians
• Nurse Clinicians
• Pastoral Care Provider
/ Medical Social
Worker

SPH Palliative Care Section
In-Patient
Consultation
Service
In-Patient
Hospice
Components of
Palliative Care
Section
Out-Patient
Clinic

SPH Palliative Care Section
Components
In-Patient
consultation service
– Referral system
– Patients remain under
the care of their
attending physicians

SPH Palliative Care Section
Components
In-Patient hospice
– 2-bedded facility
– Terminally ill patients
may be warded if
dying or deemed too ill
to be sent home
– Advanced directives
must be executed
prior to transfer

SPH Palliative Care Section
Components
Out-Patient clinic
– Open on weekdays,
office hours
– Palliative care consults
– Other services:
Ostomy care, wound
care, nasogastric tube
or urinary catheter
insertion/replacement

SPH Palliative Care Section
Care Path For
the Terminally Ill
To In-Patient Hospice
To Home
With Follow-up
At Palliative Care Section
Out-Patient Clinic
To Home
With Support From
Palliative Care Section

SPH Palliative Care Section Staff
Physicians
Nurse Clinicians
Pastoral Care/
Medical Social Worker

SPH Palliative Care Section Staff
• Physicians:
– Palliative Care
Consultant
– Family Medicine
Resident Physician -
Palliative Care rotator
– Residents from other
departments willing to
learn palliative care
are welcome

SPH Palliative Care Section Staff
• Nurse Clinicians:
– Interested to learn
Palliative Care Nursing
– Willing to remain in the
program
– Training to be provided by
Palliative Care Consultant
or through short courses
– Temporary attachment to a
palliative care section or
home hospice should be
considered

SPH Palliative Care Section Staff
• Pastoral Care Provider
– Preferably a SPC nun
trained in counseling
– Provide Christ-
centered psycho-
spiritual care of
terminally ill patients
and their families
– Help facilitate social
services in case no
medical social worker
available

SPH Palliative Care Section Staff
• Medical Social Worker
– Provide counseling and
psychological support
to patients and their
caregivers
– Facilitate social
services and
appropriate placement
of patients

Proposed Phases of Development
• Phase I: to start upon approval by the Hospital’s
Executive Committee
– Physicians: Palliative Care Consultant, Family
Medicine Resident - Palliative Care Rotator
– Nurses: Senior staff nurses interested in palliative
care nursing
– Pastoral Care/Social Worker: May either be from a
nun from the SPC community or social worker
sourced elsewhere
– Focus of Care: initially solely on terminally ill cancer
patients

Proposed Phases of Development
• Phase II: from 2010 onwards
– Physicians: Palliative Care Consultant, Family
Medicine Resident - Palliative Care Rotator
– Nurses: A full-time Nurse Clinicians, Senior staff
nurses interested in palliative care nursing
– Pastoral Care/Social Worker: May either be from a
nun from the SPC community or social worker
sourced elsewhere
– Focus of Care: To progress to all terminally ill patients
in need of palliative care

Cost of Running the Service
• Equipment
– Not dependent on high technology equipment
• Staff
– Palliative care staff can be sourced from
inside the hospital
– Training and employment of nurse clinicians
should be considered

SPH Palliative Care Section Benefits
• The first private and
Catholic institution in the
Western Visayas that
provides consistent and
holistic quality health care,
even at the end of life
• Ensure continuous care
for terminally ill patients
• Increased turnover of
hospital beds
• Increased patient care
satisfaction

Anticipated Paradigm Shifts
• Emphasis on quality of life
• Wider utilization of advanced directives
• A more receptive and responsive medical
and nursing staff as to the use of opioids,
particularly morphine, for end of life care
• Researches in Palliative Care

Thank you for listening!
Good morning!