From what started as an Inpatient Consultation service that provided care to over 1,000 patients, to the official establishment of the Outpatient Palliative Care Clinic in 2018, the Naef K. Basile Institute aims to fulfill the ethical responsibility of a healthcare facility involved in patient care. This service is the first of its kind in Lebanon.

• The Palliative and Supportive Care Program at AUBMC started with the establishment of an Inpatient Consultation service in 2013. This service has been supporting medical teams throughout the Medical Center by providing expert management of pain and other symptoms, counseling patients and families as they make difficult decisions about medical treatments and providing discharge planning as patients prepare to transition out of the Medical Center. By the end of 2018, the team has provided care to over 1,000 patients. The service has become a significant resource providing an additional layer of support for patients receiving care at AUBMC and their caregivers.

 

• In 2018, the Palliative and Supportive Care Program launched an Outpatient Palliative Care Clinic. With the official establishment of this essential and fundamental practice in healthcare systems, the Naef K. Basile Institute aims to fulfill the ethical responsibility of a healthcare facility involved in patient care. This service is the first of its kind in Lebanon, and it aims to support patients and families by providing palliative care early in the course of a serious or chronic illness simultaneously with curative treatment. The multidisciplinary team includes 4 physicians, 3 nurses, a social worker, a psychologist and a pharmacist working together to support patients and families whose lives are affected by a serious illness.

 

• Since 2018, the Palliative and Supportive Care Program at Naef K Basile Cancer Institute continues to provide care to more than 500 patients per year who have been diagnosed with life threatening conditions including, and not limited to,  lung, heart , kidney, neurologic and cancer diseases as well as frailty.  

 

• In parallel, our team started the Outreach Program which aims to check on patients that were identified to require more support and guidance in managing their symptoms after they have been discharged from the hospital. The main objectives of this program is to make sure that patients are doing well during the transitory phase back home, to adjust their medications and manage their symptoms as needed. We work closely with our patients’ primary and specialty care providers, as well as with community organizations that offer home nursing and other services.

 

• The Palliative and Supportive Care Program also started the Bereavement Program in March 2018 to provide psychosocial support, accompanying families and caregivers up to one year after a patient’s death. This is provided through a series of follow-up calls after (a) one week, (b) 40 days, (c) 6 months and (d) one year. Through this program, we also identify whether a family member is at risk of complicated grief; In the event someone has been identified to be at risk of developing a psychological complication, they would be followed up by our psychologist and/or social worker depending on their situations and needs.

MISSION:
The Palliative and Supportive Care Program at AUBMC is committed to improving the quality of life, maximizing the functionality and relieving the suffering of patients with serious illness and their families through patient care, advocacy, capacity building and research. We aim to deliver compassionate care of the highest standards based on the best available scientific evidence.

VISION:
To serve as a model and resource in palliative care to healthcare institutions in Lebanon and the region.

• Palliative care is for people of any age who have chronic illness that might affect the quality of their life. It can be provided at any stage during the course of treatment if the condition has been affecting their quality of life. It is provided regardless of the treatments received and whether the condition is curable or not. Patients may receive palliative care simultaneously while receiving other treatments.

• Research has shown that integrating palliative care with the treatment plan early in the course of a serious illness can help patients cope better with their treatment. We work closely with patients, their families and their primary physicians to help patients remain comfortable, functional and have all the information needed to make the decisions that are right for them.

The Palliative and Supportive Care Program provides specialized multidisciplinary services to patients and their families in both the inpatient and outpatient settings. Services are available to anyone with a serious illness regardless of age, diagnosis or prognosis. Our care is provided alongside curative treatments and continues if curative treatment is no longer an option. The services provided depend on the needs of patients and their families.

They include:

1. Symptom Management: Most serious illnesses are associated with uncomfortable symptoms either from the disease itself or its treatment. Symptoms such as pain, shortness of breath, fatigue, anxiety, nausea or vomiting can be debilitating and have a significant impact not only on the quality of life, but also on the ability to tolerate treatment. Palliative care providers are the experts in managing such symptoms. Patients living outside Beirut who have received care by the palliative team may continue to receive support by telephone through the program’s outreach service.

2. Assistance with Planning and Decision Making: Living with a serious illness can be very challenging. Patients and families often find it difficult to accept a new diagnosis, make choices about their treatment and understand how this will affect their lives. The palliative care team at AUBMC develops and plans its care according to the wishes of the patient in collaboration with their family and their primary care physician. We provide them with the needed information to help them make sense of the treatment options and guide them throughout the process.

3. Counseling Services: The impact of a serious illness is not limited to the patient. It affects the person living with the illness and everyone around them. Patients and families can have significant difficulty coping with the illness and figuring out how to deal with it. What do you tell the patient? If there are children involved, what do you tell them and how do you help them cope? What kind of information should you ask for? How do you communicate with doctors and nurses? How do you deal with the cost of treatment and obtain medications? How do you navigate the hospital system and health insurance providers?

These are only some of the questions that patients and families may have. The palliative care team can provide counseling and support to help patients and families at various stages of the illness as they learn to cope and adjust. Through the bereavement program, the palliative care team also provides support and guidance to families and caregivers up to one year following the passing of a loved one.

4. Discharge Planning: After receiving treatment at the Medical Center, patients and their families might find going back home overwhelming especially if there has been deterioration in the health status. The palliative and supportive care team can intervene by anticipating the challenges associated with that transition and work with the family to facilitate this step. We empower caregivers by teaching them how to provide proper care to their loved ones and support them during their illness. Our team also supports by assessing needs for medical equipment and connecting the patient to community resources and home based palliative care services when needed.

• Palliative and supportive care operates through the entire continuum of care associated with an illness and the whole course of disease, whether during or after illness, a family may face.

 

• The loss of a loved one can be devastating. Our bereavement program helps a deceased patient’s family members to cope better with their loss.

 

• The bereavement program provides supportive care through bereavement counseling and follow-up care: offering psychosocial support, accompanying families and caregivers up to one year after a patient’s passing.

 

• In the event a family member is at risk of complicated grief or at risk of developing a psychological complication, our psychologist and/or social worker follows-up with the families depending on their situations and needs.

 

Please consult the below documents that may help describe some of the feelings that can arise from losing a significant other and offer some guidance on how to cope with bereavement:

 

• Helping yourself grieve when your spouse dies
• Helping children cope with grief
• Supporting a bereaved loved one 
• The Grief Experience
• Stages of Grief
• Difference between Normal and Complicated Grief

The Palliative and Supportive Care Program aims to serve as a model and resource in palliative care to healthcare institutions in Lebanon and the region.

In this capacity, it provides educational programs and training opportunities for health care professionals so that they can become providers of palliative care in their communities.

Integrating the concepts of palliative care in the curricula of medical and nursing schools and spreading awareness about palliative care are done through:

 

1. Palliative Care Education Program: includes a 4-week module which has become a requirement for second year medical students and a one-week rotation with the palliative care team. This program has been rated very highly by medical students as it allows them to have some exposure to the principles and concepts of palliative care.

2. Palliative Care Championship Program: was developed and implemented by our team targeting nurses at AUBMC to help us raise awareness about palliative care. The main objective of this program is to assign palliative care champions at a number of units at AUBMC and train them to identify, support and advocate for patients whose disease is significantly affecting their quality of life.

3. Awareness Campaigns: are organized on regular basis to raise awareness among patients, families and staff members about the palliative and supportive care program and the importance of the services it provides in relieving patients’ suffering and improving their quality of life at the hospital.

4. Updating or developing evidence-based guidelines, and tools on palliation as appropriate, including pain management options in adults and children.

The Palliative and Supportive Care Program conducts research and performance improvement initiatives to help advance in the field and contribute to the current knowledge base: 

1. Impact of Palliative Care on Healthcare Costs in Lebanon: is a study that was conducted to assess the impact of palliative care on the healthcare cost. This is very important because findings will provide critical information to hospital administrators, health insurers and policy makers as they work to integrate palliative care into healthcare systems.

2. Distress Thermometer Project: was initially implemented to assess the distress levels among cancer patients admitted to the NKBCI infusion unit. The findings obtained showed a substantial presence of distress among those patients more than that reported internationally, and a huge discrepancy between high distress and number of referrals to the palliative and supportive care team. As a result, the automatic referral of severely distressed patients to palliative care was implemented as an intervention. This allowed us to provide the needed services to more than 60 distressed patients, relieving their suffering and supporting their families.

3. Other ongoing research topics include: “Where do Lebanese Patients Prefer to Die?” and “The effects of oxycodone versus morphine for patients complaining of shortness of breath”.

 

 

VIEW PALLIATIVE AND SUPPORTIVE CARE PROGRAM ACTIVITIES

Rana Yamout, MD

ry30@aub.edu.lb, 01 374444 ext 8092

Rana earned her medical degree at Saint Joseph University (USJ) in 2009 and completed her residency in Anesthesiology and Critical Care at Hotel Dieu de France (HDF) hospital in Beirut, and later in Paris. While in France, she completed a fellowship in chronic pain triggering her interest in caring for the seriously ill. She therefore went on to pursue a Masters of Research in Palliative Medicine at the University of Paris Descartes and completed further training in pain management and palliative care at Gustave Roussy Institute and Bichat hospital. She was also a visiting fellow in pain management and palliative care at the Hackensack University Medical Center in New Jersey in September 2015.

Since returning to Lebanon in 2015, Rana established a palliative care consultation service at Clemenceau Medical Center (CMC) where she worked as an anesthesiologist. She also contributed to the establishment and operationalization of the palliative care unit at Hotel-Dieu de France hospital in 2017. Rana has been on the faculty at the American University of Beirut Medical Center (AUBMC) since 2018, serving as a member of the Palliative and Supportive Care Team with an appointment in the Department of Anesthesiology where she contributes to both the pain service and anesthesiology services.

 

Nazem Bassil, MD

nb24@aub.edu.lb, ext. 5800 – 7480

Dr. Bassil is the associate program director of the Geriatric Medicine Program at AUBMC. Dr. Bassil earned his Medical degree from the Lebanese University in 2002, and did residency training at the University of Baland and at AUB’s Family Medicine Residency Program.

This was followed by a fellowship iin Geriatric Medicine at the Saint Louis University Schiool of Medicine. He also completed a fellowship in Geriatric Psychiatry at Saint Louis University. Nazem was a family physician at Saint Georges Hospital University Medical Center specialising in family medicine, geriatric medicine and psychiatry and palliative care.

Dr. Bassil joined AUBMC as a clinical associate professor in 2021 and specializes in family medicine, palliative care and geriatric medicine.

 

Karim Farah, MD

kt19@aub.edu.lb, ext 8092

Dr. Karim completed his undergraduate education (BS in Biology) and his medical degree in June 2006 at the American University of Beirut. He then did his Internship, Residency, Fellowship in Pulmonary and Critical Care Medicine at AUB. His work experience includes being a Pulmonologist at Wellbeing Center and Bellevue Medical Center, as well as the Bekhazi Medical Group (Khoury Hospital). The focus of his clinic is respiratory disorders (asthma, emphysema, lung infections, pulmonary fibrosis, and lung cancer; and symptoms such as shortness of breath and cough) and critical illness (conditions such as sepsis, respiratory failure, and multiple organ failure).

The palliative approach comes naturally to Dr. Farah and his background in Pulmonary Medicine is invaluable to chronic care patients. Karim joined the AUBMC internal medicine department as part of palliative care team as of Nov 2019.

 

Hibah Osman, MD, MPH, Founding member

Hibah graduated from the American University of Beirut Faculty of Medicine (AUB FM) in 1995. She completed her residency in Family Medicine at the Medical University of South Carolina in 1998 and received a Master of Public Health (MPH) from the University of Illinois at Chicago in 2000. She received training in Palliative Medicine at the Institute of Palliative Medicine at San Diego Hospice and Harvard Medical School. She is American Board certified in both Family Medicine and Hospice and Palliative Medicine.

Hibah established the Palliative and Supportive Care Program at AUBMC in 2013. She is also the founder of Balsam – the Lebanese Center for Palliative Care- the first NGO to deliver home-based palliative care services in Lebanon. Through her work at AUBMC and Balsam, she has been actively involved in service delivery, program building, advocacy, training and research at the national and regional levels. She serves on the National Committee for Pain Control and Palliative Care at the Ministry of Public Health.

 

Hala El Amin, MSc, Licensed Clinical Psychologist

he105@aub.edu.lb

Hala graduated from the University of Reading, UK with an MSc in Clinical Aspects of Psychology. She has completed clinical training at the American University of Beirut Medical Center’s Clinical Psychology Training Program. Hala currently practices as a licensed adult clinical psychologist at her  private practice.

Her interest and experience in palliative care began in June 2022, when  she joined SANAD NGO for Home Hospice Care of Lebanon as a psychologist. Hala is currently enrolled in a Fellowship program in palliative care at the Institute of Palliative Medicine in Kerala, India and St. Christopher Hospice in the UK.

 

Rayane DAHER, Pharm.D., Senior Clinical Pharmacist

rd51@aub.edu.lb, Ext. 5293

Dr. Rayane Daher earned her Bachelor’s degree in Pharmacy at Beirut Arab University in Beirut, Lebanon in 2016 in addition to her Doctor of Pharmacy degree (Pharm.D.) in 2017. She did her training in different hospitals in Beirut including AUBMC, MGH, and Military Hospital. She worked as a community pharmacist for 2 years before joining the American University of Beirut Medical Center – Pharmacy Department in 2018 as an attending clinical pharmacist in the oncology team. She is an active member of professional societies including The Order of Pharmacists of Lebanon.

Dr. Rayane joined the palliative care team in 2021 where she reviews patient’s therapy plan and assists in limiting drug – drug interactions and reducing the adverse effects of medications.

 

Janane Hanna, MSN, RN, AOCNS

jh25@aub.edu.lb,

Janane holds a BS degree in Nursing from the American University of Beirut (AUB)( 2005), and  a Master’s degree in Nursing-Adult Track from AUB (2009). She is certified as an Advanced Oncology Clinical Nurse Specialist from ONCC since 2011 (renewed in 2015). She has received training in pain and palliative care at a number of leading centers including Johns Hopkins University Hospital, MD Anderson Cancer Center, St. Christopher’s Hospice, London and Al-Malath Foundation in Amman, Jordan.

After five years as an oncology nurse at AUBMC, she moved to the pain service to become the first Pain Nurse at AUBMC in 2010 getting promoted to Pain Clinical Nurse Specialist in 2012. Janane is very active in the field of pain and palliative care. She is a member in the Subcommittee on Practice of the National Committee for Pain Control and Palliative Care and a founding team member of Balsam, the Lebanese Center for Palliative Care – an NGO that provides community-based palliative care services. She has played an important role in establishing the Hospital-based Palliative Care Service at AUBMC. Her efforts locally have earned her international recognition, and she has been elected to serve as a task force member in the American Society for Pain Management Nurses Pain Outcome Metrics.

Janane has been working on improving pain management practices through the education and training of physicians and nurses at AUBMC and has presented nationally and internationally on topics related to pain and palliative care. she was appointed as an Academic Associate at Hariri School of Nursing, American University of Beirut in 2016. She is a member of many professional nursing societies like the Oncology Nursing Society, American Society of Pain Management Nursing, and Honor Society of Nursing Sigma, Theta Tau International.

She is a coauthor on the report “Setting practice standards for palliative care in Lebanon. Recommendations of the Subcommittee on Practice – National Committee for Pain Control and Palliative Care”.

 

Rebecca El Asmar, MSN, RN, CNS

re12@aub.edu.lb, ext 6219

Rebecca holds a BS degree in Nursing from the American University of Beirut (AUB)(2004), and aMaster’s degree in the Adult Care track in Nursing from AUB (2009). In 2011, she obtained her Advanced Oncology Clinical Nurse Specialist (AOCNS) certification from the Oncology Nursing Certification Corporation (ONCC). She has worked as an oncology nurse at AUBMC since 2004 and was promoted to Adult Oncology Clinical Nurse Specialist in 2012. She has undergone clinical observerships in oncology and palliative care at Johns Hopkins Hospital and MD Anderson Cancer Center, with training at Al-Malath Foundation in Jordan and St. Christopher’s Hospice in London.

In her role as oncology CNS at AUBMC, Rebecca encounters oncology patients at all stages in their disease trajectory and works to support them and their families throughout. She believes that caring for patients with cancer requires not only skill but also passion and patience. She continuously works on developing her skills as well as updating and sharing her knowledge in oncology and palliative care.

Rebecca participates in training physicians and nurses and has presented in several national and international conferences on the topics of oncology and palliative care. In 2016, she was appointed as an Academic Associate at the AUB Hariri School of Nursing. She is a founding team member of Balsam and a member of professional nursing organizations such as the Oncology Nursing Society and the Honor Society of Nursing – Sigma Theta Tau International.

 

Nora Hijal, MS, BSN, RN

nh98@aub.edu.lb, ext 6921 6923

Nora Hijal is an accomplished nurse who has made significant contributions to the field of healthcare. She obtained her nursing degree from the prestigious American University of Beirut (AUB) in 2013, followed by a graduate degree in Biomedical Sciences from AUB in 2021.

Since joining the AUB Medical Center (AUBMC) as a Registered Nurse (RN) in 2013, Nora has demonstrated exceptional skills and commitment. She initially worked in the Pediatric Intensive Care Unit for four years, providing critical care to young patients. In 2017, she transitioned to the Coronary Care Unit, where she continues to excel in delivering sterling patient care.

Nora’s dedication and expertise extend to advanced therapies, including LVAD (Left Ventricular Assist Device), ECMO (Extracorporeal Membrane Oxygenation), CRRT (Continuous Renal Replacement Therapy), and Hypo/Normothermia. Her proficiency in these specialized treatments led to her recognition as the Best Coronary Care RN, receiving the esteemed Physician’s Award in 2021.

Currently, Nora works closely with the Palliative Care Team as an RN, providing compassionate support to patients and their families. Moreover, she is an American Hear Association certified instructor, imparting her knowledge and skills through Advanced Cardiac Life Support (ACLS) classes since 2021 and Basic Life Support (BLS) classes since 2018.

Beyond her clinical responsibilities, Nora serves as a clinical coordinator for the Advanced Trauma Life Support (ATLS) program since 2013. In this role, she coordinates and facilitates training programs to enhance trauma care, demonstrating her commitment to continuous learning and improvement.

Nora Hijal is a member of the prestigious Nursing Honor Society, Sigma, Theta Tau International, reflecting her exceptional achievements and commitment to excellence in nursing.

 

Veronique El Khoury, MS

va14@aub.edu.lb, ext 8432

Veronique El Khoury is a licensed dietitian who earned her Master’s degree in Human nutrition at Notre Dame University (NDU) in 2021. She completed her dietetic internship at the NDU Hospital-Jounieh, where she implemented the Nutrition Care Process according to established standards, working with individuals ranging from infants to elderly, addressing a diverse range of medical and nutrition diagnoses.

During her graduate years, Veronique worked as a graduate teaching assistant, where she assisted faculty professors by performing teaching or teaching-related duties. Her academic journey included the publication of three research papers on topics related to nutrition and health. Veronique also actively pursued certified training and workshops in research and nutrition, spanning regions such as Lebanon, USA, Europe, and UK.

In 2022, Veronique embarked on an internship and research assistant role at DiaLeb, a Lebanese non-governmental organization. There, she dedicated her efforts to research initiatives and media outreach, actively promoting diabetes awareness. She participated in seminars, support groups and workshops organized by DiaLeb and its international partners. Two of her scientific articles, drafted during her training, were featured as posters at the 2022 International Diabetes Federation (IDF) Congress held in Lisbon, Portugal. In recognition of her outstanding contributions, Veronique received the Advocacy Ambassador Award from Dr. Jackie Maalouf, founder and president of DiaLeb, and was honored with a Blue Circle Pin by the IDF MENA Chairperson in January 2023.

In March 2022, Veronique joined AUBMC as the Palliative Care and Tumor Boards Coordinator at the Naef K. Basile Cancer Institute. She facilitates and actively attends weekly virtual and in-person meetings and tumor boards, managing logistics, correspondence, presentations, and minute-taking. Additionally, Veronique oversees the management of palliative care patient databases, ensuring timely data entry and providing insightful figures, primary metrics, and key performance indicators for the Palliative Care Service. Her responsibilities also extend to organizing Palliative Care fundraising and awareness events, where she manages logistics, conceptualized theme ideas, and planned budgets. Veronique also continues to sharpen her research skills, actively engaging in studies within the field of Palliative Care.

Roula Mashmoushi, RN

rm103@aub.edu.lb, ext 6282

Roula holds a BS degree in Nursing from the American University of Beirut (AUB) (2011). She has over 8 years of nursing experience in medical, oncology and palliative care. Roula joined the palliative care team at AUBMC in 2018 and has actively pursued gaining more experience in the field. Her professionalism and passion towards palliative care allowed her to establish a good position for herself in a very short period of time gaining patients’ and their families’ trust.

She is a member of many professional nursing societies such as Oncology Nursing Society, American Society of Pain Management Nursing, and the Honor Society of Nursing Sigma, Theta Tau International.

 

Maria Bekdache Tamim, MSW

mb47@aub.edu.lb, ext 6716

Maria  holds a BS degree in Social Work (1999) a Master’s degree (2003) and a Teaching Diploma (2002)from the Saint-Joseph University (USJ) . Maria joined the social work department at AUBMC in 2004 and has been a member of the Palliative Care Committee and the Palliative Care Service since August 2013.

In 2018, she joined the Palliative and Supportive Care Program. Through her collaboration and coordination with the palliative care team  members, she provides psychosocial support to patients and family members who are experiencing emotional distress, facilitates discharge planning, prepares caregivers on how to approach their children in case of a parent’s loss, provides supportive counseling to family members of a deceased patient (as part of bereavement program) and collaborates with the palliative care psychologist for patients experiencing complicated grief.

Maria continuously improves her practice through education and training, addressing emerging developments related to social work practice in palliative care. She has attended several workshops and trainings related to palliative care, most recent of which was the 16th World Congress of the European Association for Palliative Care in Berlin-Germany.

She also received a number of certificates in 2017 widening  her knowledge of palliative care practice: “Palliative Care: Making It Work” with Future Learn Website-Lancaster University  “Palliative Care”- Course funded by the Australian’s Government Department of Health.

Maria also provides orientation sessions about the functions and services of the Social Work Department to medical and nursing students.

Palliative care can be provided in the hospital, in outpatient clinics, or at home. If you think you can benefit from palliative care, check with your doctor or nurse to arrange for a consultation.

To schedule an appointment with one of our Palliative Care physicians, Dr. Rana Yamout or  Dr. Nazem Bassil, kindly contact the outpatient hematology oncology clinics on 01-315 000, Ext. 8092.

• Location: AUBMC, ACC Building, 5^th floor
• Date and Time: Mondays from 8 am till 12 pm

                                   Fridays from 1 pm to 5 pm

Palliative care consultations can be done using one of the following services:

1. Inpatient Consultation Service: The aim of the inpatient consultation service is to provide an interdisciplinary team approach to support patients and their families and encourage them to make informed decisions about their medical care that are in line with their values and belief system.

• This service is available to patients admitted to any unit in the Medical Center including medical, surgical, emergency, short stay, and intensive care units. Referrals are usually made by the patient’s physician and the palliative care team would perform an assessment to decide on the patient’s needs and then the team would strive to understand the patients’ and their families’ wishes and goals, which together with the medical assessment of needs, are used to tailor a personalized plan for care.

• Patients are seen daily by the palliative care nurse, the physician and other team members who follow up on patients and their families to provide one or more of the following services: symptom management, assistance with planning and decision making, counseling services and discharge planning. Our clinical psychologist, social worker and pharmacist also offer support to nurses and physicians based on patients’ needs to provide optimal care.

 

The Palliative and Supportive Care team can be reached at pager # 1554.

 

2. Outpatient Clinics: Patients can also be referred to the palliative care outpatient clinics to provide any of the services provided by the palliative and supportive care team: symptom management, assistance with planning and decision making and counseling services.

The Palliative and Supportive Care Clinics are located at the ACC (Halim and Aida Daniel Academic and Clinical Center), 5th floor. This service is available to all patients with serious illness and their families regardless of diagnosis or the stage of their illness. Our services are not restricted to patients with cancer. We provide care to patients with advanced or progressive illnesses, including but not limited to heart, lung, kidney or neurological diseases. The palliative care team can support patients by helping them understand their diagnosis, make sense of their treatment plan, plan for the future, and maintain control of their lives. Our focus is to help patients and families feel more comfortable and supported.

To schedule an appointment, please call 01/759618 extension 7980.