Pippa Hawley UBC and BCCA Vancouver July 2016 Objectives Discuss words used when talking about palliative care Present a visual model to help you describe its various aspects to patients families colleagues and the ID: 632813
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Slide1
Palliative Care:Emergency Room Interaction
Pippa Hawley,
UBC and BCCA, Vancouver
July 2016Slide2
Objectives
Discuss words used
when talking about
palliative care
Present a visual model to help you describe it’s various aspects to patients, families, colleagues and the
public
Give you confidence in knowing what to say when your patient is seriously illSlide3
ACTIVE (“CURATIVE”) TREATMENT
PALLIATIVE
CARE
Historical
Understanding of Palliative CareSlide4
Focus
of
care
Therapy to modify disease
Bereavement
CHPCA Model ~
yr
2000
Hospice
Palliative Care
This is still referred to as the ”new” model in many references Slide5
What Patients S
ee
(Google Images search )Slide6Slide7
“This is Not For Me”
T
oo little palliative care too late
No time for advance care planning
Low expectations for symptom management
Expectation of suffering
Caregiver burden
High cost (taxpayers and families)Slide8
WHO Definition
Palliative care
is an
approach
that improves the quality of life of patients and their families facing the problem associated with
life-threatening illness
, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Slide9
WHO Definition Continued…
………early
in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications
.Slide10
Integration of Palliative Care with Disease Management
There is now clear evidence that Specialist Palliative Care
Consultation….
Improves quality of life of patients
Improves quality of life of care-givers
Reduced dysfunctional grief
Increases the chance of death occurring in the chosen location (home or hospice
vs hospital)Slide11
Reduces risk of inappropriate interventions,
e.g..
ICU admissions where no advance care planning has been done
chemotherapy within last days/weeks of life
Reduces costs to health care system
ER admissions
Acute bed stays
Doctor visitsIntegration of Palliative Care with Disease ManagementSlide12
2. NEJM 2010;363:733-742
Mass. General Study
Increased survival;
Temel
et al 2010
2
RCT of mandatory
US Cancer centre-based PSMPC clinic referral at diagnosis of metastatic lung cancer
vs discretionary referral by oncologist
Median Survival11.6 vs. 8.9 monthsp<0.02Slide13
Integration of Palliative Care with Disease Management
PC is most valuable when integrated early
in the
course of illness,
particularly in care for chronic illness where a
palliative approach
to care is most appropriatePC is shifting from focus on cancer to focus on all diseases with differing illness trajectories and care needsPrognostication is getting harder with new disease-modifying medical advances
There is no longer a “right time” for palliative care referralSlide14
A New Model of Integrated Palliative Care
Disease
Management
Palliative
CareSlide15
Disease
Management
Palliative
Care
Chemotherapy
Radiotherapy
Targeted therapy
Surgery
Hormone therapy
Transfusions
Anti-nausea drugs
Antibiotics
A New Model of Integrated Palliative CareSlide16
Disease
Management
Palliative
Care
Hospice
Survivorship
End of Life Care
Symptom Management
Advance Care Planning
Rehabilitation
Bereavement
Palliative Care Unit
Cure
Control
A New Model of Integrated Palliative CareSlide17
Goals for Bowtie Model
Accurately describe the current
WHO definition of palliative
care, for our patients, their families
and our colleagues
Emphasize that a definite and inevitably fatal course is not a prerequisite for eligibility
“If you get over this we will all be thrilled”
“If you don’t, you will have had access to the best possible care, all the way along”Slide18
Specialist Palliative Care
Specialist Palliative Care is provided by a specially-trained team of doctors, nurses, social workers and other specialists who work together with a patient’s primary care team to provide an extra layer of support for people with serious illness.
It
focuses on providing relief from the symptoms and improving quality of life for both the patient and the family.
It
is appropriate at any age and at any stage of a life-threatening illness and can be provided along with curative-intent treatment.Slide19
Specialist Palliative Care Services
Unable to take care of all of clinical needs
Often rationed arbitrarily according to prognosis
We are not very good at prognostication
Barriers to access including DNR status: this should be a goal, not a requirement
Mis
-use of the word “palliative” as a euphemism for many concepts,
e.g “dying”, “incurable”, “close to death”, “suffering greatly” etc. No wonder patients don’t want it!Slide20
Hospice
Care that focuses on relieving symptoms and supporting patients with incurable illness that have a life expectancy of weeks to months.
In
most cases hospice care is provided to a patient in his or her own home.
It
also can be provided in freestanding hospices, hospitals, nursing homes and other long-term care facilities
.Slide21
The medical specialty focusing on the knowledge and skills which make up the physician’s role in providing specialist palliative care, including teaching and research.
Palliative Medicine