Sat | Feb 17, 2018

Doctor's Appointment | Treating people beyond their illness

Published:Wednesday | February 22, 2017 | 12:00 AM
Dr Sara Lawrence, host of 'Dr's Appointment', shares lens time with consultant in oncology and palliative care at the Hope Institute, Dr Dingle-Spence, after discussions on palliative care as well as the need for families to rally around loved-ones who are terminally ill.

As a faith-based nation, we understand the inevitability of death, but how many of us know the road to death does not have to be painful? For your appointment this week, we take a close look at a targeted kind of care known as palliative care. Consultant in oncology and palliative medicine at the Hope Institute, Dr. Margaret Dingle-Spence joins us.

Palliative medicine is an alternative approach to caring for a person who is facing an active, progressive, and/or far-advanced illness who may have a short prognosis, or little time before facing death.

Unlike mainstream medicine that focuses on the disease, palliative care is fundamentally about viewing patients as a whole individual, the prevention and relief of suffering, and finding ways to improve the quality of the life they have left.

This area of treatment is often misunderstood as 'end of life care', which is but one aspect of possible treatment.

With a team of specialists from varying disciplines, a layered approach to intervention is facilitated. It, therefore, looks at the spiritual, physical, emotional and psychosocial aspects of the individual, as well as taking into consideration the suffering that persons close to the patient may experience.

The speciality is not bound to any specific age group or kinds of illnesses. It is applicable to children and can intervene on cases of dementia, Alzheimer's, a range of cancers, among others. However, in Jamaica, the spectrum of diseases is not as diverse as obtains in the developed world.




Palliative care physicians rely on a performance status scale also used by regular doctors to decide on the path treatment should take, judging each patient solely on his/her own condition.

The Zubrod or Eastern Cooperative Oncology Group (ECOG) Performance Scale ranges from 0-4, with each value describing a patient's ability to undergo certain treatments, assist themselves with tasks an average person carries out daily, and prognosis.

According to the scale:

A. 0 Fully functional and physically strong with minor symptoms.

B. 1 Experiences symptoms, able to move, carry out light work and personal upkeep.

C. 2 Occasional assistance is needed to complete tasks; able to move more than 50 per cent

D. 3 Move about for less than half of the day; requires nursing care.

E. 4 Completely bedridden.

Patients who are borderline 2, 3 or 4 are not typically given treatment that is likely to weaken them, taking them closer to death.




Dr Dingle-Spence noted that to ensure the best care for loved ones at home who require palliative medicine, we must:

- Understand symptoms the person is experiencing;

- Consult with a doctor or seek out institutions that are best aligned to those needs, where necessary;

- Pay attention to the person's level of comfort;

- Allow open communication;

- Accept the individual's eating limitations and do not force or overfeed;

- And most importantly, be patient and focus on the person behind the illness.

- If you missed this episode you can watch the rebroadcast tomorrow at 9:00 am on TVJ and remember to join us next week at 5:30 pm when we look at Adverse Childhood Experiences (ACES) - how childhood trauma contributes to diseases in adulthood, with Dr. Carolyn Jackson, Consultant Paediatric Surgeon and Executive Clinical Director at Caribbean Tots to Teens.

- We invite you to share your feedback on our Facebook page @DoctorsAppt