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Palliative Care Across the Continuum of Illness

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Title: Palliative Care Across the Continuum of Illness


1
Palliative Care Across the Continuum of Illness
  • Jean Endryck, FNP-BC, ACHPN, NE-BC
  • Director of Palliative Care
  • St. Peters Health Partners/Seton Health
  • Troy, New York
  • July 23, 2013

2
I, Jean Endryck, do not have any relevant
financial interests or other relationships with a
commercial entity producing healthcare-related
products and/or services.
3
Learning Objectives
  • Identify the principles of Palliative Care
  • Understand how Palliative Care applies across the
    continuum of illness

4
OLD LANGUAGE
Palliative care is the medical specialty focused
on improving the quality of life of people facing
serious illness. Emphasis is placed on pain
and symptom management, communication and
coordinated care. Palliative care is appropriate
from the time of diagnosis and can be provided
along with curative treatment. Source 2011
Public Opinion Research on Palliative Care CAPC
5
NEW YORK STATE LAW
Palliative care, as defined by the law, is
health care treatment, including
interdisciplinary end-of-life care, and
consultation with patients and family members, to
prevent or relieve pain and suffering and to
enhance the patients quality of life, including
hospice care PHL 2997-c and 2997-d
6
NEW LANGUAGE
Palliative care is specialized medical care for
people with serious illnesses. This type of care
is focused on providing patients with relief from
the symptoms, pain, and stress of a serious
illness whatever the diagnosis. The goal is to
improve quality of life for both the patient and
the family. Palliative care is provided by a
team of doctors, nurses, and other specialists
who work with a patients other doctors to
provide an extra layer of support. Palliative
care is appropriate at any AGE and at any STAGE
in a serious illness, and can be provided
together with CURATIVE TREATMENT. Source 2011
Public Opinion Research on Palliative Care by CAPC
7
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8
NATIONAL CONSENSUS PROJECT Third Edition, 2013
  • Developed clinical practice guidelines for
    quality Palliative Care which are
  • Define the essential elements of palliative care
  • Drive development and improvement in clinical
    programs
  • Help clinicians incorporate palliative care into
    routine practice
  • Promote quality, consistency and reliability of
    services
  • Foster access to palliative care across the
    continuum of health care services

9
NATIONAL CONSENSUS PROJECT
DOMAIN 1 Structure and Processes of
Care DOMAIN 2 Physical Aspects of
Care DOMAIN 3 Psychological and Psychiatric
Aspects DOMAIN 4 Social Aspects of Care
10
NATIONAL CONSENSUS PROJECT (continued)
DOMAIN 5 Spiritual, Religious, and Existential
Aspects of Care DOMAIN 6 Cultural Aspect of
Care DOMAIN 7 Care of the Patient at the
End-of-Life DOMAIN 8 Ethical and Legal
Aspects of Care
11
NATIONAL QUALITY FORUM (NQF)
2012 report identified a framework and set of NQF
endorsed preferred practices that focus on
improving palliative care across the Institute of
Medicines six dimensions of quality-safe,
effective, timely, patient-centered, efficient,
and equitable The preferred practices mark a
crucial step in the standardization of palliative
care and hospice There are 38 preferred
practices Source www.qualityforum.org
12
PALLIATIVE CARE VS HOSPICE
  • All of hospice is
  • palliative care,
  • but not all of
  • Palliative care is
  • hospice

Palliative Care
Hospice
13
ASCENSION HEALTH MODEL
14
The Joint Commission Advanced Certification
Program for Palliative Care
  • Started in 2011
  • Signifies that hospitals are committed to patient
    and family centered care
  • Certification based on clinical practice
    guidelines through the National Quality Forum
    Consensus Report
  • NQF has identified 38 preferred practices that
    focus on improving palliative care and hospice
    care across the IOM six dimensions of quality,
    safe, effective, timely, patient centered,
    efficient, and equitable

15
CLINICAL INTERSECTIONS
Modified from Diane Meier, MD CAPC
16
CONTINUUM OF ILLNESS
  • FACT Approximately 90 million Americans live
    with at least one chronic disease.
  • FACT In New York City, the average person with
    a serious illness receives care from 12
    specialists, with no one coordinating care
  • Source Dartmouth Atlas of Health Care

17
Continuum of Illness Adult and Pediatric
  • Hospital Palliative Care Teams
  • Emergency Department IPAL-EM
  • Intensive Care Units IPAL-ICU
  • Medical Floors
  • Outpatient IPAL-OP covering clinic, home based
  • Assisted Living Homes
  • Nursing Homes, Skilled Nursing Facilities

18
CONTINUUM OF ILLNESS
  • Pulmonary
  • Heart Failure
  • Dementia
  • Hepatic
  • HIV/AIDS
  • Neurological Diseases and Trauma
  • Renal
  • Cancer

19
EVIDENCE OF SUCCESS
  • 2010 NEJM research study showed that patients
    with metastatic non-small cell lung cancer who
    received early palliative care along with
    standard treatment lived on average THREE MONTHS
    LONGER (11.6 months vs. 8.9 months)
  • Pain and symptoms were well managed resulting in
    less admissions to the ED or inpatient
  • Patients in the study experience less depression
    and improved QOL
  • Chose less aggressive care at EOL
  • Source Temel, J.S., et.al. (2010). Early
    Palliative Care for Patients with Metastatic
    Non-Small cell lung cancer. NEJM(363), 733-742.

20
CONCLUSION
  • DONT delay Palliative care for a patient with
    serious illness who has physical, psychological,
    social, or spiritual distress because they are
    pursuing disease directed treatment
  • Numerous studies including randomized trials
    provide evidence that palliative care improves
    pain and symptom control, improves family
    satisfaction with care, and reduces costs
  • Palliative care does not accelerate death and may
    prolong life in selected population
  • Source Five things Physicians and Patients
    should question in hospice and palliative
    medicine. Choosing Wisely an initiative of the
    ABIM Foundation. Aahpm.org/choosingwisely

21
QUESTIONS?
22
RESOURCES
  • Center to Advance Palliative Care www.capc.org
  • American Academy of Hospice and Palliative
    Medicine www.aahpm.org
  • Hospice and Palliative Nurses Association
    www.hpna.org
  • National Consensus Project for Quality Palliative
    Care www.nationalconsensusproject.org
  • National Quality Forum (NQF) Consensus Report
    www.qualityforum.org

23
RESOURCES
  • Education in Palliative and End of Life
    Education www.epec.net
  • ELNEC www.aacn.nche.edu/elned
  • EPERC www.eperc.mcw.edu
  • Get Palliative care resource for families at
    www.getpalliativecare.org

24
REFERENCES
  • 2011 Public Opinion Research on Palliative Care
    accessed www.capc.com
  • New York State Palliative care act accessed
  • www.health.ny.gov/professionals/patients/patient_r
    ights/palliativecare/practitioners/resources.htmp
    rognosis
  • National Consensus Project (NCP) Third Edition,
    2013 accessed www.nationalconsensusproject.org
  • National Quality Forum (NQF) 2012 accessed
    www.qualtiyforum.org

25
REFERENCES
  • Dartmouth Atlas of Health Care accessed
    www.dartmouthatlasofhealthcare
  • Temel, J.S., et.al.(2010). Early Palliative care
    for patients with metastatic non-small cell lung
    cancer. NEJM (363), 733-742.
  • Choosing wisely an initiative of the ABIM
    Foundation accessed www.aahpm.org/choosingwisely

26
(No Transcript)
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