Illness in the Past
For thousands of years, little was known about the pathophysiology of disease. As a result:
- Sanitation was poor
- Childhood mortality was high
- Primary disease-modifying therapies were lacking
- Average life expectancy was under 50 years (though those who
survived into adulthood could expect to live into their 60s)
Until the mid 1900s, while most medical care of patients with serious life-threatening
illness had a curative intent, it was ineffective. When someone became ill, usually from an
infection or accident, there was little that could be done to control their disease or their
suffering:
- Early surgery was primitive and often failed because of infection, bleeding or other complications
- There were few useful medications
- Analgesics and anaesthesia were almost unknown
- The few existing physicians were not accessible to the general
population
Death was an event expected by everyone.
Beyond a few scattered "hospice" residences and sanitoria, there were few places
whose special mission was to care for the sick or dying. While these places
took care of the dying, they didn't have any special expertise or a clinical work
from which to care for the dying. As most families lived close together and supported each
other, the sick were cared for in their homes. As most people died soon after the onset of
disease (hours to days), the burden on families to care for them was relatively brief.
Those who survived an acute event often experienced prolonged disability and suffering
as there was little that could be done to relieve their symptoms or disabilities.
Scientific advances, however, have led to Progress fighting Disease
Resources:
1)
Field MJ, Cassel CK.
Approaching Death: Improving Care at the End of Life.
Washington, DC: Institute of Medicine, National Academy Press, 1997.
2)
EPEC Plenary 1: Gaps in End-of-life Care
 |
Home •
Development •
Rationale •
Elements •
Lexicon •
Resources •
FAQ
Summary •
Overview •
Contributors •
Help •
Get Acrobat •
Contact Us
|
|
CAPCManual Attribution:
von Gunten CF,
Ferris FD,
Portenoy RK,
Glajchen M, eds.
CAPCManual: How to Establish A Palliative Care Program.
New York, NY: Center to Advance Palliative Care, 2001.
©
Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, CA
and
The Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, 2001
Permission to reproduce for non-commercial educational purposes with display of
attribution and
copyright is granted.
Last updated: February 20, 2002
|
|
|
Rationale
Select section:
Changing Illness Experience
Changing Expectations and Needs
Progressive Healthcare Response
Responding to the Opportunity
•
Changing Illness Experience
Illness in the Past
Progress Fighting Disaese
Illness Today
Prolonged Illness Experience
Chronic Disease Process
Determining Prognosis
Cancer
Manifestations
Predicament
Prolonged End-of-life Experience
Sudden Unexpected Death
Predictable Decline
Slow Decline, Multiple Acute Crises
Death in the US
Leading Causes of Death
Setting of Death
Desired
Reality
Multiple Issues Cause Suffering
The Square of Care
Morbidity
Pain
Need for Assistance
Social, Financial Impact
Implications for Care
Variable Need for Care
Opportunities
For Patients
For Families
•
Changing Expectations and Needs
Increased Consumer Autonomy
Picker Institute 8 Dimensions of Care
Goals, Not Problems, Drive Care
Shift to Goal-oriented Care
Expect Competence, Expertise
Expect Comprehensive Assessment
Expect Effective Communication
Expect Participation in Decision-making
Expect Timely, Continous, Coordinated Care Delivery
Expect Assistance with Caregiving
Caregiver Training, Support
Caregiver Financial Support
Alternate Settings of Care
Respite Relief
•
Progressive Healthcare Response
Focus on Disease-modifying Therapy
Focus on Care of the Dying
Early Hospice
Modern Hospice Movement
Dame Cicely Saunders
Origins of "Palliative Care”
Evolution of Hospice, Palliative Care
In United Kingdom
In Canada
In United States
Convergent Evolution
Hospice, Palliative Care in US Today
Hospice Growth
Continued Unmet Opportunity
A Public Health Issue
•
Responding to the Opportunity
Paradigm Shift in Thinking
Provide Concurrent Care
Consider Application to Those at Risk
Expand Services, Settings of Care
1º, 2º, 3º Model of Delivery
Expand Access to Expertise
Create Specialized Environments
Many Names, Same Focus of Care
|
