About

iPal Global is a free, downloadable app that provides access to essential palliative care information in any care setting, including locations with limited internet access or phone service. Guidelines have been tailored for use in resource-constrained environments where clinicians may not have easy access to all medications or therapies.

The app offers concise management suggestions and options in four topic areas:

• Assess: Use the screening tool to assess whether your patient needs palliative care
• Manage: Determine which medications and therapies to use for common symptoms
• Plan: Access aids for planning future care and decision-making
• Communicate: Make communication therapeutic by using talking tips for breaking bad news, CPR, prognosis, goals of care, end-of-life and specific situations

There is also an interactive Scale to help you assess and monitor symptom severity.

The content for the iPal Global app was developed by Romayne Gallagher MD, CCFP(PC), FCFP, a Canadian palliative care expert with more than 25 years of experience providing clinical palliative care across hospitals, hospices, homes and outpatient departments. Dr. Gallagher is a Clinical Professor in the Department of Family Medicine at the University of British Columbia. iPal Global focuses on how to provide a high level of palliative care using the most widely-available medications and therapy. The content has been verified by clinicians working in India and Africa as part of the Two Worlds Cancer Collaboration.

This app was reviewed and additions recommended by: Dr. Gillian Fyles (Two Worlds Cancer Collaboration (TWCC)), Dr. Jean Jacob Mathews (TWCC, MNJ Institute of Oncology & Regional Cancer Center, India) and Dr. Jonathan Pearce (Providence Health Care and TWCC).

Dr. Srini Chary gave a significant donation to St. Paul’s Hospital Foundation to fund the app.

The original app was modified and proofread by members of the Hospice Palliative Care Program at Providence Health Care.

Providence Health Care is a faith-based healthcare organization that has a Hospice Palliative Care Program of 3 palliative consultation teams (2 acute care teams, 1 residential team) 12 acute palliative care beds and 14 hospice beds. The team works with partner organizations in the community and other health authorities to provide care for patients from across the province of British Columbia.

Providence is a teaching and academic facility associated with the Faculty of Medicine at UBC and we have many learners come through our program. They have also contributed excellent ideas to help improve the app.

The app was developed in response to a study done across our organization that showed that the quality of care for at end-of-life varied dramatically.

The app was made to be used in caring for patients anywhere and aims to provide essential and useful clinical information.

The app and accompanying website were designed and developed by Monkey Hill Health Communications.

What is Palliative Care?

Palliative care is an approach that improves the quality of life of patients and their families who are facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Benefits of the palliative approach for the patient include:

• better symptom management and reduced suffering
• increased understanding of illness and fewer concerns about the future
• maximized quality of life
• treatment consistent with patient/family goals of care

Benefits of the palliative approach for the clinician include:

• focus of care is symptom management and improving quality of life – not disease indices
• knowing patient/family goals of care avoids futile diagnostic/therapeutic measures, and smoother decision-making
• greater professional satisfaction because patient/family more satisfied with care
• reduced length of stay and health care costs

For more information on essential practices of palliative care visit the International Association for Hospice & Palliative Care

General

• Pereira JL, Associates. The Pallium Palliative Pocketbook 2nd edition, 2011; Oxford Handbook of Palliative Care, 2nd Edition, 2010
• Surgical Care at the District Hospital WHO 2003
• WHO Essential Medicines in Palliative Care 2012
• International Association for Hospice Palliative Care List of Essential Medications for Palliative Care 2013 www.supportiveoncology.net
• WHO Symptom Management and End-of-Life Care for First-Level Facility Health Workers 2004

Delirium assessment/management

• Inouye SK, et al. The Confusion Assessment Method. Ann Intern Med. 1990; White J. et al. CHIMBOP J Palliat Med. 2008.

Opioids: Palliative Opioid Prescribing Tool

• Gallagher R, CMAJ 2011 and the Providence Health Care Palliative Care Program

Palliative Approach Assessment Tool

• Boyd K. & Murray S. British Medical Journal 2010;
• Weissman D., Meier D. Journal of Palliative Medicine 2011;
• Salpeter S. et al Am. J Medicine 2011;
• Salpeter S. et al J. Palliative Med. 2012;
• Freeman L. Curr Opin Support Pallat Care 2009;
• Celli R. Respiratory Medicine 2010;
• Crockett et al. Qual Life Res 2002;
• Louvet et al. Hepatology 2007;
• Mitchell S. et al. JAMA 2010;
• Fausto & Selwyn Prim. Care Clin.Off. Pract. 2011.

Plan

• Girota et al NEJM 2012;
• Holmes et al Arch intern Med 2006

Communication

• Chochinov. ABCD of Dignity Conserving Care British Medical Journal, 2007

Palliative Approach Assessment Tool

• Epner & Baile Annals of Oncology 2012;
• Kleinman et al. Ann Intern Med. 1978

Self Care

• Gallagher R. Compassion fatigue. Canadian Family Physician 2013; 59: 265-68
• Kearney MK, Weininger RB, Vachon ML, Harrison RL, Mount BM. Self-care of physicians caring for patients at the end of life: “Being connected…a key to my survival”. JAMA 301(11):1155-64.