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Hospice Basics: Palliative Care vs. Curative Care

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Hospice Basics: Palliative Care vs. Curative Care In order to reach that goal we will cover the following areas over the next hour. By the end of this presentation ... – PowerPoint PPT presentation

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Title: Hospice Basics: Palliative Care vs. Curative Care


1
Hospice BasicsPalliative Care vs. Curative Care
2
Goal
  • To educate health care professional
  • about hospice, specifically palliative care
  • as compared to curative care in order to
  • provide more
  • appropriate and
  • quality hospice
  • care for terminally
  • ill patients and
  • their families.

3
Objectives
  • Describe the history and philosophy of the
    hospice movement.
  • Identify the difference between palliative and
    curative care.
  • List the benefits of palliative care in the
    terminally ill patient.
  • List some therapies that are
  • palliative but may be consider curative.

4
A Bit of History
  • Dying in the 19th Century
  • 3 of Americas population was gt65.
  • Life expectancy was 45-50 years.
  • Most people died at home.

5
And Then Today
  • Dying in the United States
  • 13 of the population is gt 65 years.
  • Approximately 75 of Americans die in health care
    facilities.
  • 57 die in hospitals.
  • 17 die in
  • long term care
    facilities.

6
Hospice
  • The origin of the word hospice was used to
    describe a shelter or haven for the weary
    traveler
  • The term has come to be
  • associated with support
  • and care
  • Shelter from discomfort is provided to enable
    dying patients to approach death in a peaceful way

7
History of Hospice
  • 1905 St. Josephs
  • 1967 St. Christophers in London
  • 1969 Elizabeth Kubler-Ross
  • On Death and Dying
  • 1974 New Haven Hospice of CT
  • First hospice in the US

8
What is Palliative Care?
  • The study and management of patients with
    active, progressive, far-advanced disease for
    whom the prognosis is limited and the focus of
    care is quality of life.

Oxfords Textbook of Palliative Medicine
9
Palliative Care
  • Affirms life.
  • Regards dying as a normal process.
  • Neither hastens nor postpones death.
  • Provides relief from pain other symptoms.
  • Integrates the psychological spiritual aspects
    of care.
  • Provides support for patient and family.

World Health Organization
10
Hospice defines Palliative Care
  • The aggressive treatment of physical and
    emotional pain symptoms
  • An active treatment plan,
  • but not intended to
  • cure the patients
  • underlying disease
  • All palliative treatments focus on enhancing a
    residents comfort overall quality of life

11
The Goal of Palliative Care
  • The goal of palliative care is helping
  • patients to achieve and maintain
  • maximum physical, emotional, spiritual,
    vocational and social potential,
  • despite the progression
  • of their terminal illness.

12
Palliative Care Realized
  • This goal is fully realized when the patient
    experiences the following
  • Relief from pain
  • Psychological and spiritual care
  • A support system which assists the patient to be
    as actively as he or she wishes
  • A support system to sustain the patients family

13
End of Life Physical Symptoms
  • Unrelieved pain
  • Shortness of breath
  • Nausea Vomiting
  • Confusion
  • Restlessness
  • Itching
  • Disturbed bladder and bowel function
  • Disrupted sleep
  • Cachexia
  • Pain and symptom management are the first
    priority in palliative care

14
Psychosocial / Spiritual Symptoms
  • Psychosocial
  • Depression
  • Anxiety
  • Ineffective Coping
  • Ineffective Communication
  • Life Role Transition
  • Caregiver Distress
  • Spiritual
  • Despair / Hopelessness
  • Powerlessness
  • Loneliness
  • Need for Reconciliation
  • Psychosocial and spiritual symptoms that are
    part of the dying process are addressed

15
Palliative Care vs. Curative Care
  • Curative Care
  • Disease driven
  • Curing the disease is foremost
  • Doctor in charge
  • Disease process is primary
  • Few choices
  • Palliative Care
  • Symptom driven
  • Comfort quality of life
  • Patient is in charge
  • Disease process is secondary to person
  • Many choices

16
Freedom to Choose
  • Palliative Care redirects energy
  • Patients and Families drive the Plan of Care
  • Patients and Families choose what is important to
    accomplish
  • Physical,
  • Psychosocial or
  • Spiritual

17
Palliative Care Misconceptions
  • Hospice / palliative care means doing nothing
  • All treatments are discontinued
  • All invasive interventions
  • such as chemotherapy or
  • radiation are stopped

18
Misconceptions
  • Hospice / palliative care means doing nothing
  • FACT
  • The goal is to assist the patient to achieve
    quality of life
  • Patient drives the Plan of Care
  • All decisions are weighed
  • More choices give to
  • patient and family

19
Another Misconception
  • All treatments are discontinued
  • FACT
  • All decisions about treatments (to initiate
  • or discontinue) are
  • weighed against the
  • goal of palliative care.

20
Misconceptions about Invasive Interventions
  • All invasive interventions such as chemotherapy
    or radiation are stopped
  • FACT
  • Yes, there are such things
  • as palliative chemotherapy
  • and palliative radiation
  • therapy

21
Principles for use of Invasive Palliative
Interventions
  • What does the patient want?
  • What is the life expectancy of the patient?
  • What is the patients baseline level of function?
  • What is the goal or expected outcome of the
    proposed intervention?
  • Weinreb N. Twenty Common Problems in End of Life
    Care, 2001

22
Patient Wishes
  • What does the patient want?
  • Is what the patient wants medically indicated?
  • What is the physicians
  • obligation?
  • Weinreb N. Twenty Common Problems in End of Life
    Care, 2001

23
Patient Prognosis
  • Will the patient live long
  • enough to complete the
  • treatment?
  • Will the patient live long
  • enough to benefit from the
  • treatment?
  • Weinreb N. Twenty Common Problems in End of Life
    Care, 2001

24
Patients Functional Status
  • Ability of patient to tolerate treatment
  • Potential for improvement in quality of life
  • Potential complications
  • Discomfort to patient
  • Inconvenience to patient
  • Potential toxicities and
  • side effects
  • Weinreb N. Twenty Common Problems in End of Life
    Care, 2001

25
Palliative Chemotherapy
  • Clinical Benefit Response to Chemotherapy
  • Sustained Improvement in Pain
  • Decreased pain with no change in analgesia
  • Same level of pain with less analgesia
  • Improvement in
  • Performance Status
  • Stabilization or gain in weight
  • Weinreb N. Twenty Common Problems in End of Life
    Care, 2001

26
Indications for Palliative Radiation
  • Bone pain secondary to metastases
  • Neurological deficits associated with brain
    metastases
  • Malignant dysphagia due to tumor obstruction
  • Painful hepatomegaly
  • Pulmonary symptoms
  • Pelvic masses associated
  • with pain or obstruction
  • Weinreb N. Twenty Common Problems in End of Life
    Care, 2001

27
Palliative Radiation Therapy
  • Pain, bleeding, and obstruction may be relieved
  • Radionuclides and hemibody radiation for systemic
    pain
  • Key issue relates to dosing
  • Short or single fractionation schemes are
    preferred
  • An increased risk of long term toxicity should
    not be an issue in patients near the end of life
  • Weinreb N. Twenty Common Problems in End of Life
    Care, 2001

28
In Conclusion
  • Palliative Care affirms life and attempts to
    relieved pain and suffering
  • Palliative Care is symptom driven with the
    patient in charge
  • Every treatment or intervention must be
    questioned
  • Some treatments and therapies normally viewed as
    curative can be and are palliative
  • Chemotherapy
  • Radiation

29
In every sufferer, Let me see the Human
Being -Maimonides
30
Hospice BasicsPalliative Care vs. Curative Care
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