EQUITY IN ACCESS TO PALLIATIVE CARE

On the International Day of Palliative Care, a message from Dr. Rana Yamout on the aim of

palliative and supportive care to leave no one behind. 

PALLIATIVE AND SUPPORTIVE CARE PROGRAM

CANCER PATIENTS HEALTH DURING COVID-19

Dr. Rana Yamout, acting director of the Palliative and Supportive Program on safeguarding and treating cancer patients during the COVID-19 pandemic

PALLIATIVE AND SUPPORTIVE CARE PROGRAM

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.

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.

More information about what Palliative and Supportive Care is about at the following video link: https://bit.ly/30LFeaA.

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.

ACTING DIRECTOR OF PALLIATIVE & SUPPORTIVE CARE PROGRAM DR. RANA YAMOUT TALKS ABOUT THE IMPORTANCE AND BENEFITS OF PALLIATIVE CARE:

WHAT IS PALLIATIVE CARE?
  • Palliative care is specialized medical care for people with serious illness. It is patient and family-centered care that focuses on relieving suffering and helping patients maintain the best possible quality of life by maximizing their overall functionality, despite a life-limiting illness. Palliative care provides a specialized multi-disciplinary approach in managing the physical, psychological, social, and spiritual sources of distress in patients regardless of age, diagnosis, or prognosis.
  • Palliative care is not only for cancer patients. It can benefit any patient with a chronic condition affecting his/her quality of life, whether that condition is a chronic lung disease condition, heart failure, or a chronic neurological disease etc.
  • Palliative care should not be reserved for patients with terminal illness who are at the end of life. It can and should be provided to patients receiving active curative therapies when their medical condition or its treatment causes significant suffering. Patients who receive palliative care along with their curative treatment have a better quality of life and as a result have a better ability to tolerate their treatments.

 

PROGRAM BROCHURE:

HISTORY
  • 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.
  • 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 AND VISION

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.

WHO BENEFITS FROM PALLIATIVE CARE?
  • 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.
PALLIATIVE CARE AND SUPPORT CARE SERVICES

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.

BEREAVEMENT PROGRAM
  • 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:

 

EDUCATION AND CAPACITY BUILDING

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.

RESEARCH AND PERFORMANCE IMPROVEMENT INITIATIVES

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”.

MEET OUR TEAM

Hibah Osman, MD, MPH

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.

 

Rana Yamout, MD

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.

 

Antoine Finianos, MD

Antoine received his MD at the American University of Beirut Faculty of Medicine (AUB FM) in 2003. He then completed his residency in Internal Medicine at AUBMC in 2006 and later pursued a residency in Internal Medicine at the University of Texas Health Science Center at Houston in 2009. Within the same year, he joined a private practice in Texas. During that time, he also served as the Associate Medical Director for Lighthouse Hospice and later as the Medical Director for Rose of Texas Hospice.

Antoine returned to Lebanon after completing a fellowship in Hematology/Oncology at the George Washington University Hospital at Washington, DC in 2016. He joined Keserwan Medical Center (KMC) in 2016 as a full-time faculty to establish the Hematology/Oncology program. Antoine later joined AUBMC in 2017 to help expand the palliative and supportive care program.  Antoine is board certified in Internal Medicine, Hospice and Palliative Care, Hematology and Medical Oncology.

 

Janane Hanna, MSN, RN, AOCNS

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

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.

 

Roula Mashmoushi, RN

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

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.

 

Hiba Salem, MA, MAET

Hiba graduated from the American University of Beirut (AUB) with a BA in Psychology and a Teaching Diploma in Art and Music in 2007. She completed her Masters of Art in Mental Health Counseling and Expressive Therapy at Lesley University in Cambridge in 2012 and her Masters of Art in Clinical Psychology at Boston University in 2014. She has worked in various clinical contexts including Inpatient Psychiatric Hospitals in Boston, and in research contexts, including Harvard University and Boston University. She is certified in Expressive Therapy (Art Therapy, Music Therapy, Play Therapy), Interpersonal Therapy (Columbia University) and is currently undergoing CBT certification.

She is a member of the American Psychological Association, the British Psychological Society, and the Psi Chi: International Honor Society in Psychology.

After working for years within the refugee population, Hiba joined SANAD: Home Hospice Care in 2017 as a psychologist and Head of Mental Health Unit, and joined the Palliative and Supportive Care Program at AUBMC in 2018. Hiba has been engaged in further developing the role of mental health within hospice and palliative care settings through material development, research, and trainings.

As part of her own development within the domain of Palliative and Hospice Care, Hiba has partaken in a palliative observership at Mass General Hospital, Dana Farber Cancer Institute, and Care Dimensions in Boston, MA in January 2019, and has gotten certified in Psycho-Oncology by the University of Toronto in August 2019.

Through her work at AUBMC and SANAD, she has been actively involved in service delivery, program building, advocacy, training and research.

 

Maha Wazne, BS Pharm, MS

Maha  holds a BS degree in Pharmacy from the Lebanese American University (LAU) (2011) and  a Masters degree in Clinical Pharmacy from the Lebanese University (2017). After joining the American University of Beirut Medical Center in 2011 as an Attending Clinical Pharmacist – Oncology Team she was promoted to the position of senior attending clinical pharmacist In 2015. Maha provides pharmacy services for the inpatient/outpatient hematology/oncology Units (Basil Cancer Center and St Jude) including rounding with the medical team, and documenting her interventions and therapeutic drug monitoring on patients.

Maha is involved in development, revision and validation of chemotherapy order sets (solid tumors and Pediatric BMT). She represents the pharmacy department on several committees including Basil Cancer Center Collaborative Practice Team. Maha has given a variety of presentations to nurses and pharmacists on local and national level. Maha is also a preceptor for PGY1 pharmacy residents for the pediatric oncology rotation at AUBMC Pharmacy Residency Program. She is an active member in the Order of Pharmacists of Lebanon.

 

Lama Zahreddine, MSc

Lama holds a Bachelor of Science degree from the American University of Beirut (AUB) with a Major in Medical Laboratory Sciences and a Minor in Public Health (2008); and a Master of Science degree in Microbiology and Immunology (2011) from AUB. Lama also completed one semester of the PhD program in Clinical-Bioanalytical Chemistry/Cellular and Molecular Medicine Specialization at Cleveland State University, OH in 2012.

After returning to Lebanon, she joined the Anesthesiology Department at the American University of Beirut Medical Center (AUBMC) in 2013 as a Clinical Research Assistant. She then moved to the Children’s Cancer Institute (CCI), AUBMC in 2014 and served as the Clinical Trials Coordinator.

Through her work at AUBMC, she has established herself in the healthcare sector and has been involved in Clinical Trials coordination as well as Healthcare, Research and Medical Programs Management. She is skilled in Programs Coordination and Administration, Clinical Data Management, Patient Recruitment and Follow-up, Medical Programs’ Financial Planning and Budget Preparation, as well as other tasks related to Healthcare Administration and Clinical Research field.

Lama has joined the Palliative and Supportive Care Program as the Program Coordinator since September 2020. She enthusiastically works with the Palliative care team to coordinate the administrative tasks and to develop the program including services’ expanding, performance improvement and research activities.

LOCATION AND APPOINTMENT SCHEDULING

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 at the Palliative and Supportive Care clinic, contact us by calling 01 – 759 618 or 01 – 350 000 ext. 7980.

 

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 is available Monday – Friday from 8:00 a.m. – 4:00 p.m., and 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.

For Palliative and Supportive Care Program Activities – Click this Link

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