Implementation of Palliative Care Report Palliative care ...
PALLIATIVE CARE UPDATE
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Transcript of PALLIATIVE CARE UPDATE
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PALLIATIVE CAREUPDATE
PALLIATIVE CAREUPDATE
BY
SALLY SAMPLE, MDBY
SALLY SAMPLE, MD
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LIFE IS SHORTLIFE IS SHORT
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Employment AffiliationsEmployment 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
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
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FINANCIAL DISCLOSUREFINANCIAL DISCLOSURE
• I have no financial gains or incentives for this talk
• I have no financial gains or incentives for this talk
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GOALSGOALS
• 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
doesn’t mean we SHOULD• To remember:
Everyone dies--it is not a failure
• 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
doesn’t mean we SHOULD• To remember:
Everyone dies--it is not a failure
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SUMMARYSUMMARY
• DEFINITIONS
• HISTORY stigma of death and dying
• PC Today and the HCP role– Some relevant references to the literature– Legislation– National and State Trends
• DEFINITIONS
• HISTORY stigma of death and dying
• PC Today and the HCP role– Some relevant references to the literature– Legislation– National and State Trends
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PC DEFINITIONSPC 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
--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
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PC DEFINITIONS PC DEFINITIONS
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GRAPHGRAPH
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HISTORYHISTORY
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HISTORYHISTORY
• PALLIATIVE CARE: OLDEST FORM OF MEDICINE
• NEWEST SUBSPECIALTY
• PALLIATIVE CARE: OLDEST FORM OF MEDICINE
• NEWEST SUBSPECIALTY
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PALLIATIVE CAREPALLIATIVE 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
19th century and before:
approach to illness involved family, church,
very few life prolonging treatments
family at death bed
dying was part of life
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PALLIATIVE CAREPALLIATIVE CARE
• 19th century and before
• Health Care Provider Role:
Diagnosis and Prognosis– Whether the patient would succumb
• 19th century and before
• Health Care Provider Role:
Diagnosis and Prognosis– Whether the patient would succumb
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PALLLIATIVE CAREPALLLIATIVE CARE
• Civil War changed nature of death and dying--no longer family at death bed
This Republic of Suffering. By Drew Gilpin Faust
• Civil War changed nature of death and dying--no longer family at death bed
This Republic of Suffering. By Drew Gilpin Faust
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PALLIATIVE CAREPALLIATIVE CARE
• Mid 20th Century---life prolonging Rx• Prognosis gave way to treatment
– Antibiotics in WWII– CPR– Gastrostomy tubes– ICU’s– Other life sustaining/prolonging treatments
• Mid 20th Century---life prolonging Rx• Prognosis gave way to treatment
– Antibiotics in WWII– CPR– Gastrostomy tubes– ICU’s– Other life sustaining/prolonging treatments
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PALLIATIVE CAREPALLIATIVE CARE
• mid 20th century
– Prognosis took lesser role
– Emphasis on treatment
• mid 20th century
– Prognosis took lesser role
– Emphasis on treatment
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PALLIATIVE CAREPALLIATIVE 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
• 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
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WHERE ARE WE TODAY?WHERE ARE WE TODAY?
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CARTOONCARTOON
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PALLIATIVE CARE TODAYPALLIATIVE 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
Website:CAPC.org
• 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
Website:CAPC.org
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PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
ALLEVIATE SUFFERING ALLEVIATE SUFFERING
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PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• HCP’s Role • Prognosis
• Giving patients choices
• Talk of death and dying when appropriate
• Referral to palliative care and hospice when appropriate
• HCP’s Role • Prognosis
• Giving patients choices
• Talk of death and dying when appropriate
• Referral to palliative care and hospice when appropriate
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PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• HCP’s Role– Prognosis
• HCP’s Role– Prognosis
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DEATH TRAJECTORY and PROGNOSISDEATH TRAJECTORY and PROGNOSIS
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DEATH TRAJECTORY and PROGNOSISDEATH TRAJECTORY and PROGNOSIS
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DEATH TRAJECTORY and PROGNOSISDEATH TRAJECTORY and PROGNOSIS
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DEATH TRAJECTORYDEATH TRAJECTORY
• Prognosis dwindling patient• Prognosis dwindling patient
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DWINDLING PATIENTDWINDLING PATIENT
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DWINDLING PATIENTDWINDLING PATIENT
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HCP’S ROLEHCP’S 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 doctor’s prognoses in terminally ill patients: prospective cohort study; BMJ 320, 469-72.
• 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 doctor’s prognoses in terminally ill patients: prospective cohort study; BMJ 320, 469-72.
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PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• HCP’s Role– Giving patients choices
• HCP’s Role– Giving patients choices
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PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• Giving patients choices:
• POLST--Cal Legislation AB 3000
effective January 1, 2009
• Giving patients choices:
• POLST--Cal Legislation AB 3000
effective January 1, 2009
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
• TALK OF DEATH AND DYING
– Legislation “Patient Self Determination Act” of 1991• Requires inpatients be asked about advance care
directives
• TALK OF DEATH AND DYING
– Legislation “Patient Self Determination Act” of 1991• Requires inpatients be asked about advance care
directives
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S 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
• 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
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
• NEXT YEAR in Contra Costa County:
– A Pilot program for Medi-Cal and End-of-Life
administered by APS Healthcare--more next year
• NEXT YEAR in Contra Costa County:
– A Pilot program for Medi-Cal and End-of-Life
administered by APS Healthcare--more next year
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
• Talk of Death and Dying– Why is it so hard for us
• Talk of Death and Dying– Why is it so hard for us
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
• Talk of Death and Dying--Myths– The hard conversation will depress patients– Patients will lose hope– Saying it will make it happen
• Talk of Death and Dying--Myths– The hard conversation will depress patients– Patients will lose hope– Saying it will make it happen
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
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HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
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SUMMARYSUMMARY
• 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
• 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
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THANK YOUTHANK YOU
• Sally Sample, MD
• Email [email protected]
• Sally Sample, MD
• Email [email protected]