Palliative CareResearch Advocacy Training and Support Program 

Our webinar will begin shortly.

WELCOME!

• Speaker(s): Jean S. Kutner, MD, MSPH

• Archived Webinars: FightColorectalCancer.org/Webinars

• AFTER THE WEBINAR: Expect an email with links to the material & a survey. If you fill it out, we’ll send you a Blue Star pin.

• Ask a question in the panel on the RIGHT SIDE of your screen

• Follow along via Twitter – use the hashtag #CRCWebinar

Today’s Webinar:

What is a RESEARCH ADVOCATE? A research advocate brings a patient viewpoint to the research process and communicates a collective patient perspective

Fight CRC’s Research Advocacy Training and Support (RATS) Program: • Goal is to improve the ability of research

advocates to effectively participate in the research process.

• In person meetings, online trainings, and webinars.

• Continued education and ongoing training and support

Brought to you by RATS:

Resources:

Disclaimer:

The information and services provided by Fight Colorectal Cancer are for general informational purposes only. The information and services are not intended to be substitutes for professional medical advice, diagnoses or treatment.

If you are ill, or suspect that you are ill, see a doctor immediately. In an emergency, call 911 or go to the nearest emergency room.

Fight Colorectal Cancer never recommends or endorses any specific physicians, products or treatments for any condition.

Speaker:Dr. Kutner is a tenured Professor of Medicine in the Divisions of General Internal Medicine (GIM), Geriatric Medicine, and Health Care Policy and Research at the University of Colorado School of Medicine (UC SOM). She is Board Certified in internal medicine, geriatric medicine and hospice and palliative medicine and cares for patients on the palliative care service and in general internal medicine clinic.

Her research focuses on improving symptoms and quality of life for hospice and palliative care patients and their family caregivers. On July 1, 2014, Dr. Kutner became the inaugural Chief Medical Officer of University of Colorado Hospital and Associate Dean for Clinical Affairs, UC SOM.

Palliative Care

Fight Colorectal Cancer WebinarJanuary 29, 2016

Jean S. Kutner, MD, MSPHProfessor of Medicine, University of Colorado School of Medicine

Chief Medical Officer, University of Colorado Hospital

Palliative Care

When is the “right” time?What are its benefits?

LT’s story• LT – 43 year old woman, previously healthy• Worsening hip pain – thought to be a running injury• Diagnosed with metastatic cancer by MRI• Confirmed as colorectal cancer• Sources of suffering:

– Pain– Sudden serious illness diagnosis– Uncertain future– Decision making about treatments

What is Palliative Care?• Specialized medical care for people with serious illness and

their families– Focused on improving quality of life as defined by patients and

families.– Provided by an interdisciplinary team that works with patients,

families, and other healthcare professionals to provide an added layer of support.

– Appropriate at any age, for any diagnosis, at any stage in a serious illness, and provided together with disease treatments.

Definition from public opinion survey conducted by ACS CAN and CAPC http://www.capc.org/tools-for-palliative-care-programs/marketing/public-opinion-research/2011-public-opinion-research-on-palliative-care.pdf

Palliative Care Components

Hospice CarePalliative Care

Advance Directives

ImproveCommunication

Pain &

Symptom Management

Goals of Care

Difficult Decisions

Palliative Care: Concurrent with Disease-Directed Therapies

Medicare Hospice Benefit

Life Prolonging Care Not this

Palliative Care

Bereavement

Hospice CareLife ProlongingCare

But this

Dx Death

13

Hospice• focus is on pain and

symptom management • patient has a terminal

diagnosis with life expectancy of less than six months

• not seeking curative treatment

Palliative Care• focus is on pain and

symptom management • patient does not have to be

terminal • may still be seeking

disease-directed treatment• is not linked to

reimbursement

Hospice vs. Palliative Care

HospicePalliative Care

Have serious or advanced illness and:• Bothersome or difficult to control psychological or

physical symptoms• Desire for more information about what the future

holds, wanting to make informed decisions• Frequent hospitalizations or ER visits• Progressive inability to care for self• Caregiver distress• Long hospitalization without evidence of progress• In ICU setting with poor prognosis

Who Might Consider Palliative Care?

Palliative Care: Key Components• Multidimensional assessment

– Sources of distress– Unmet needs

• Physical symptoms• Psychological issues• Social concerns• Family difficulties• Spiritual distress

• Treatment to improve sources of distress– Skills in pain and symptom control– Ability to have conversations about tough issues

• Know about referral resources and be willing to refer for additional specialist palliative care

• Managing symptoms that cause suffering• Communication

Exploring values and patient-centered goals Helping patients assess risk, benefit, burdens Creating care plans (and back-ups) to meet

goals

Palliative Care Integrates with Disease-focused Treatments

Palliative Care as a Specialty

Medicine: American Board of Medical Specialities and American Osteopathic

Association Board of Specialities formally recognized Hospice and Palliative Medicine as a new specialty in 2006 (www.abms.org)

First board exam October 2008. First ACGME fellowship certification 2009

Nursing: National Board for Certification of Hospice and Palliative Nurses

(www.nbchpn.org) Social work

Advanced Certified Hospice and Palliative Social Worker (www.socialworkers.org)

Chaplaincy BCC-HPCC (board certified chaplain - hospice/palliative care certified)

(http://bcci.professionalchaplains.org/palliative)

• Clarification of care goals• Pain and other symptom management• Emotional, social, and spiritual support• Coordination of care

Common Reasons for Palliative Care Consultation

EXISTING EVIDENCE – BRIEF SUMMARY

Palliative Care = Quality Care

Research shows that palliative care:

• Relieves pain and distressing symptoms• Clarifies goals of care and supports decision-making• Improves quality of life• Increases patient and family satisfaction with care • Eases burden on providers and caregivers• Helps patients complete life prolonging treatments• Enhances the value of health care

Bakitas: JAMA 2009; Gade: JPM 2008.

Palliative Care Improves Quality, Reduces CostRCT of palliative care vs. usual home care for heart failure, chronic

obstructive pulmonary disease, or cancer patients (1999–2000)

13.211.1

2.3

9.4

4.6

35.0

5.3

0.9 2.4 0.90

10

20

30

40

Home healthvisits

Physicianoffice visits

ER visits Hospital days SNF days

Usual Medicare home care Palliative care intervention

Brumley, R.D. et al. JAGS 2007

Concurrent palliative care

Randomized trial: simultaneous standard cancer care with palliative care co-management from diagnosis vs standard cancer care only (non small cell lung cancer):

– Improved quality of life – Reduced major depression – Reduced ‘aggressiveness’ (less chemo < 14d before death,

more likely to get hospice, less likely to be hospitalized in last month)

– Improved survival (11.6 mos. vs. 8.9 mos., p<0.02) Temel et al. Early palliative care for patients with non-small-cell lung cancer NEJM. 2010;363:733-42

Temel et al. Early palliative care for patients with non-small-cell lung cancer NEJM2010;363:733-42.

Kaplan-Meier estimates of 1-year survival by treatment group.

Marie A. Bakitas et al. JCO doi:10.1200/JCO.2014.58.6362

©2015 by American Society of Clinical Oncology

Benefits of Outpatient Palliative Care

Four well-designed randomized interventions as well as a growing body of nonrandomized studies indicate that outpatient palliative care services can:1) improve patient satisfaction2) improve symptom control and quality of life3) reduce health care utilization, and4) lengthen survival in a population of lung cancer patients.

Morrison, R. S. et al. Arch Intern Med 2008;168:1783-1790.

Mean direct costs per day for palliative care patients who were discharged alive (A) or died (B) before and after palliative care consultation

Died:Adjusted net savings = $4908 direct costs/admission; $374 direct costs/day

Discharged alive:Adjusted net savings = $1696 direct costs/ admission;$279 direct costs/day

Consultation within 6 days reduced costs by -$1,312 (95% CI, -$2,568 to -$56; P .04) = 14% reduction in cost of hospital stay.

Consultation within 2 days reduced costs by -$2,280 (95% CI, -$3,438 to -$1,122; P .001) = 24% reduction in cost of hospital stay.

Palliative Care Improves Value

Quality improves– Symptoms– Quality of life– Length of life– Family satisfaction– Family bereavement

outcomes– MD satisfaction

Costs reduced– Hospital cost/day – Use of hospital, ICU,

ED – 30 day readmissions – Hospitality mortality – Labs, imaging,

pharmaceuticals

RECOMMENDATIONS AND GUIDELINES

Palliative care is essential to quality

8 Relevant IOM Reports:

IOM Report: Delivering High-Quality Cancer Care

To read the report online: www.iom.edu/qualitycancercare

Cancer Care Continuum

IOM Report: “Dying in America”

iom.edu/endoflife

Released 9/17/14

Key Areas for Findings and Recommendations

• Delivery of person-centered, family-oriented care• Clinician-patient communication and advance care

planning• Professional education and development• Policies and payment systems• Public education and engagement

American Society of Clinical Oncology (ASCO)

STANDARD 2.4 Palliative Care Services Palliative care services are available to patients either on-site or by referral.

COMMUNICATION IN THE SETTING OF SERIOUS ILLNESS

https://www.ariadnelabs.org/wp-content/uploads/sites/2/2015/12/Serious-Illness-Conversation-Guide-10.30.15.pdf

AVAILABILITY OF PALLIATIVE CARE IN US

Hospital Setting:• Palliative care consultation• Palliative care unit• In-hospital hospice beds

Community-based Setting:• Home-based palliative care• Clinic-based palliative care• Nursing home-based palliative care• Hospice (at home, dedicated facility, nursing home,

assisted living)

Where Can I Get Palliative Care?

State-by-State Rating (2015)

Center to Advance Palliative Care (https://reportcard.capc.org/)

2015 Report Card On Access To Palliative Care At US Hospitals

Center to Advance Palliative Care (https://reportcard.capc.org/)

2008 2011 2015

A

B

C

D

Access differs by hospital characteristics

►100% of the U.S. News 2014 – 2015 Honor Roll Hospitals Have a Palliative Care Team►100% of the U.S. News 2014 – 2015 Honor Roll Children’s Hospitals Have Palliative Care Teams

Center to Advance Palliative Care (https://reportcard.capc.org/)

Where Can I Get More Information?

Treating the person beyond the disease.

www.ariadnelabs.org

getpalliativecare.org

LT’s story• Began seeing palliative care before oncologist

• Over course of the next 11 months, LT cared for by both palliative care and oncologist– Palliative care: symptoms, support, decision making– Oncology: CRC treatment

• Partnership between palliative care and oncology allowed LT to participate in first, second and third line treatments

• Palliative care supported LT and her family in her final weeks when she decided that the burdens of cancer treatment were outweighing the potential benefits– Allowed her to achieve important goals and spend meaningful time with her

family

“A life ended with much unfinished business

or uncontrolled suffering has not been met with due

respect, and does not leave good

memories.” Dame Cecily Saunders

QUESTIONS AND DISCUSSION

Question & Answer:

SNAP A #STRONGARMSELFIEBayer HealthCare will donate $1 for every photo posted (up to $25,000).Flex a “strong arm” & post it to Twitter or Instagram! (Use the hashtag!)

Contact Us!