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PALLIATIVE CARE UPDATE

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Title: PALLIATIVE CARE AND HOSPICE Basics Author: Super User Last modified by: HCMARTINEZ Created Date: 11/30/2008 11:40:13 PM Document presentation format – PowerPoint PPT presentation

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Title: PALLIATIVE CARE UPDATE


1
PALLIATIVE CARE UPDATE
  • BY
  • SALLY SAMPLE, MD

2
LIFE IS SHORT
3
Employment Affiliations
  • Medical Director
  • Vitas Innovative Hospice, Sacramento Valley
  • Medical Director
  • End-of-life pilot for Medi-Cal administered by
  • APS Healthcare starting 2010
  • Hospitalist
  • Woodland Memorial Hospital

4
FINANCIAL DISCLOSURE
  • I have no financial gains or incentives for this
    talk

5
GOALS
  • To have everyone thinking of
  • Palliative Care when dealing with their
    chronically ill patients
  • To encourage discussions with those patients
  • To realize that just because we CAN do a
    treatment doesnt mean we SHOULD
  • To remember
  • Everyone dies--it is not a failure

6
SUMMARY
  • DEFINITIONS
  • HISTORY stigma of death and dying
  • PC Today and the HCP role
  • Some relevant references to the literature
  • Legislation
  • National and State Trends

7
PC DEFINITIONS
  • --Care of the entire person and family--physical,
    psychological, social and spiritual
  • Care to minimize Suffering
  • Cassell,E.J.(1982).The nature of suffering and
    the goals of medicine. NEJM 306(11),639-45

8
PC DEFINITIONS
9
GRAPH
10
  • HISTORY

11
HISTORY
  • PALLIATIVE CARE OLDEST FORM OF MEDICINE
  • NEWEST SUBSPECIALTY

12
PALLIATIVE CARE
  • 19th century and before
  • approach to illness involved family, church,
  • very few life prolonging treatments
  • family at death bed
  • dying was part of life

13
PALLIATIVE CARE
  • 19th century and before
  • Health Care Provider Role
  • Diagnosis and Prognosis
  • Whether the patient would succumb

14
PALLLIATIVE CARE
  • Civil War changed nature of death and dying--no
    longer family at death bed
  • This Republic of Suffering. By Drew Gilpin Faust

15
PALLIATIVE CARE
  • Mid 20th Century---life prolonging Rx
  • Prognosis gave way to treatment
  • Antibiotics in WWII
  • CPR
  • Gastrostomy tubes
  • ICUs
  • Other life sustaining/prolonging treatments

16
PALLIATIVE CARE
  • mid 20th century
  • Prognosis took lesser role
  • Emphasis on treatment

17
PALLIATIVE CARE
  • mid 20th century
  • Care of the terminally ill given less importance
    in medical training
  • Talk of death and dying became socially
    unacceptable and seen as medical failures

18
WHERE ARE WE TODAY?
19
CARTOON
20
PALLIATIVE CARE TODAY
  • Cost Reduction
  • 1. 27-30 Medicare dollars spent last year of
    life
  • 2. Palliative care services in hospitals save
    money
  • 3. Hospice referrals save money
  • Center for Advancement of Palliative Care
    WebsiteCAPC.org

21
PALLIATIVE CARE TODAY
  • ALLEVIATE SUFFERING

22
PALLIATIVE CARE TODAY
  • HCPs Role
  • Prognosis
  • Giving patients choices
  • Talk of death and dying when appropriate
  • Referral to palliative care and hospice when
    appropriate

23
PALLIATIVE CARE TODAY
  • HCPs Role
  • Prognosis

24
DEATH TRAJECTORY and PROGNOSIS
25
DEATH TRAJECTORY and PROGNOSIS
26
DEATH TRAJECTORY and PROGNOSIS
27
DEATH TRAJECTORY
  • Prognosis dwindling patient

28
DWINDLING PATIENT
29
DWINDLING PATIENT
30
HCPS ROLE
  • Prognostication
  • Difficult at best--little or no training
  • Foreseeing and Foretelling
  • Doctors are overly optimistic
  • Christakis, N.A. and Lamont, E.B. (2000).Extent
    and
  • determinants of error in doctors prognoses
    in terminally ill patients prospective cohort
    study BMJ 320, 469-72.

31
PALLIATIVE CARE TODAY
  • HCPs Role
  • Giving patients choices

32
PALLIATIVE CARE TODAY
  • Giving patients choices
  • POLST--Cal Legislation AB 3000
  • effective January 1, 2009

33
HEALTH CARE PROVIDERS ROLE
34
HEALTH CARE PROVIDERS ROLE
  • TALK OF DEATH AND DYING
  • Legislation Patient Self Determination Act of
    1991
  • Requires inpatients be asked about advance care
    directives

35
HEALTH CARE PROVIDERS ROLE
  • TALK OF DEATH AND DYING
  • California law Right to Know End-of-Life
    Options Act AB 2747
  • Enacted 5/2008
  • Patients that have a terminal illness have to be
    given accurate info about treatment options and
    pain management

36
HEALTH CARE PROVIDERS ROLE
  • NEXT YEAR in Contra Costa County
  • A Pilot program for Medi-Cal and End-of-Life
  • administered by APS Healthcare--more next year

37
HEALTH CARE PROVIDERS ROLE
  • Talk of Death and Dying
  • Why is it so hard for us

38
HEALTH CARE PROVIDERS ROLE
  • Talk of Death and Dying--Myths
  • The hard conversation will depress patients
  • Patients will lose hope
  • Saying it will make it happen

39
HEALTH CARE PROVIDERS ROLE
40
HEALTH CARE PROVIDERS ROLE
41
HEALTH CARE PROVIDERS ROLE
42
HEALTH CARE PROVIDERS ROLE
43
SUMMARY
  • Dying and death are inevitable
  • Palliative care or hospice--can alleviate
    suffering
  • Choices--we have them--think about them discuss
    them
  • With life-limiting illnesses
  • Aggressive disease modifying treatment
  • Palliative care
  • Hospice

44
THANK YOU
  • Sally Sample, MD
  • Email sasample_at_comcast.net
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