Improvement of Palliative Care in Cancer Patients in

Surgical Department
Hospital Tuanku Fauziah, Kangar
MEMBERS
Name Position
Mr. Junaidi Dr. Lee Joo Ann Dr. Valliappan Dr. Punithavathi Dr. Malini Dr. Areffuddeen Dr. Zarina SN. Duratulhanani SN. Lailatul Qamariah
Leader Member Member Member Member Member Member Member Member
Problem List
1. Poor bowel preparation leading to cancellation of colonoscopy 2. Cancellation rate of DJ stenting in HTF 3. Improvement in management of palliative care in cancer patients 4. Awaiting time of emergency surgery 5. Monitoring of critical/acute patients in general surgical ward 6. Improvement of clinic procedures on clinic days
Prioritisation
Nominal group technique (NGT) - Positive
SMART criteria
Proposed topics Bowel prep DJ stent Palliative care Emergency Surgery Serious 18 9 25 18 Measurable 18 18 27 9 Appropriate 18 9 25 18 Remedialable 27 9 27 9 Timeliness 18 9 27 9 TOTAL 99 54 131 63
Acute monitoring
Clinic procedures
18
9
18
27
18
9
27
27
18
9
99
81
Pain service Pain medication Pain Symptom free Pain chart
Oncology
Surgery
Palliative Treatment Given

Private
QOL AFTER OPTIMUM PALLIATIVE CARE RECEIVED BY CANCER PATIENTS Intensive Counseling And Education Patient Family
Government
Welfare Services
Good Nursing Care

Palliative Unit Home Visit
Experienced staff/ proper course
Advance Cancer
Diagnosis confirmed Counseling
Options of Palliative treatment
Surgical
Palliative Treatment
yes
no
Non Surgical Intervention
Pain Management Palliative Unit Nursing Care Home Visit
Palliative Care Patients

Satisfaction
MODEL OF GOOD CARE

STEP PROCESS OF CARE CRITERIA STANDARD
01
Diagnosis Counseling Patient Family
By histopathology Counseling done by: Specialists Medical Officers Hospital counselors Options discussed with the patients by: Specialists Medical Officers
Surgical intervention by: Surgeons Medical Officers
100 %
02
100 %
03
Options of Treatment
100 %
04
Palliative Treatment (Surgical)
90 %
MODEL OF GOOD CARE cont..

STEP PROCESS OF CARE CRITERIA STANDARD
05
Palliative Treatment (Non surgical)
Offered by Oncology Department

Pain management by pain service staffs and doctors Adequate pain relief, types of pain relief available Good nursing care by staff nurses, doctors and family members Home visits by palliative team Patient satisfied with the treatment given -symptom free -quality of life
80 % 90 %
06
Palliative Care
90% 80%
07
Patients satisfaction
90%
MANAGEMENT OF PALLIATIVE CARE

Management of advance cancer is challenging and forms a part of the
major workload to the Surgical Department as we dont have a proper palliative team as well as palliative unit. (INTRODUCTION) Patients with advance cancer should be treated promptly and they
need adequate care for them to have better quality of life (DESIRABLE OUTCOME/ EXPECTATION) There are ample of opportunities to make this possible in our setting.
(OPPORTUNITIES) We hope to identify areas that can be improved by carrying out a
study using certain indicators. (INTENT TO IMPROVE)
9. Main Indicator
Indicator: Percentage of satisfaction of palliative care among the Advance CA patients on palliative care
Number of Advance CA patients receiving best palliative care Total number of Advance CA patients
Inclusion Criteria
All advance CA patients that: Diagnosis have been made with histopathology Age > 18 years old Staying in Perlis
Exclusion :
Patient who are receiving treatment in other hospital but only come for acute treatment in HTF
10. Objective
General objective
To evaluate the palliative care services provided at HTF
Specific objectives
1. 2. 3. 4. To determine the quality of life among Advance Breast and Colon CA patients who are receiving palliative care treatment in HTF To identify inadequate services provided to Advance Colon and Breast CA patients in HTF To analyze the psychological and emotional care among dying Advance Colon and Breast CA patients and family To identify the approaches towards optimization of palliative care
11. Topic
Introduction
Quality of life (QOL) is a core outcome of palliative care yet in our setting, there is lack of evidence on patients level of QOL. We aim to describe the QOL among patients with incurable progressive breast and colon CA receiving palliative care in our hospital. We hope that with this study, we can improve our services to improve QOL among breast and colon CA patients.
12. Methodology of study

Type of study Definition
Cross-sectional Survey using MVQOLI questionnaire Advance CA Advance stage when curative treatment is no longer useful. Palliative Care Approach that improve quality of life of patient and family members facing problems associated with life threatening illness (WHO 2002) MVQOLI Missoula Vitas QOL Index (Byock et. al). Participating palliative care service including home care, day care, outpatient clinic and inpatient units. Descriptive statistics
Analysis
Pre intervention study Post intervention study
13. Data collection

WHAT WHO WHERE SOPD/Ward WHEN Monthly WHY Denominator HOW Cancer Registry Palliative and cancer registry book Questionnaire
Total no. of advance 1 breast and colon CA patient

No. of patients 2 receiving palliative care 3 MVQOLI Questionnaire
SOPD/Ward SOPD/Ward
Monthly Pre and post
Numerator To identify QOL
13. Data collection cont..

WHAT 4 Methods of palliative treatment WHO WHERE SOPD/Ward Home SOPD/Ward Home/Ward WHEN Monthly Daily Daily Monthly WHY To identify cause To identify the QOL To identify QOL To identify QOL HOW BHT Palliative team BHT Questionnaire
5 Palliative Visits 6 Pain treatment 7 Psychological
GANTT CHART
ACTIVITY 1
2 3 4 5 6 7 8
RESPONSIBLITY Dr. Nasir

Mr. Junaidi Mr. Junaidi Dr. Joo Ann Dr. Punitha GM GM GM
AUG
SEPT
OCT
NOV
Committee Briefing
Planning Staff Briefing Data Collection Data Analysis Remedial Action
Re evaluation
Report Writing
GM Group Member

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Surgical Department

Hospital Tuanku Fauziah, Kangar

Leader Member Member Member Member Member Member Member Member

Pain service Pain medication Pain Symptom free Pain chart

Palliative Treatment Given

Good Nursing Care

Experienced staff/ proper course

Diagnosis confirmed Counseling

Options of Palliative treatment

Non Surgical Intervention

Pain Management Palliative Unit Nursing Care Home Visit

Palliative Care Patients

MODEL OF GOOD CARE

Diagnosis Counseling Patient Family

Palliative Treatment (Surgical)

MODEL OF GOOD CARE cont..

Palliative Treatment (Non surgical)

Offered by Oncology Department

MANAGEMENT OF PALLIATIVE CARE

(OPPORTUNITIES) We hope to identify areas that can be improved by carrying out a

study using certain indicators. (INTENT TO IMPROVE)

12. Methodology of study

Pre intervention study Post intervention study

13. Data collection

Total no. of advance 1 breast and colon CA patient

Monthly Pre and post

Numerator To identify QOL

13. Data collection cont..

5 Palliative Visits 6 Pain treatment 7 Psychological

RESPONSIBLITY Dr. Nasir

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