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Palliative Medicine, UNC, 2009 Chip Baker Stephen Bernard John Valgus Gary Winzelberg PALLIATIVE CARE, WHO Palliative care is an approach which improves the quality of life of patients and their families facing life-threatening illness, through the prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems. • Palliative care: Provides relief from pain and other distressing symptoms; • Affirms life and regards dying as a normal process; • Intends neither to hasten nor postpone death; • Integrates the psychological and spiritual aspects of patient care; • Offers a support system to help patients live as actively as possible until death; • Offers a support system to help the family cope during the patient’s illness and in their own bereavement; • Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated; • Will enhance quality of life, and may also positively influence the course of illness http://www.who.int/hiv/topics/palliative/PalliativeCare/en/ What is palliative care? Interdisciplinary care to improve quality of life for patients with a terminal illness and for their family. • pain and symptom management • emotional and spiritual support • help with difficult treatment decisions Palliative care in disease course Rx to cure / treat disease Hospice Palliative Care Diagnosis 6m Death Rx to reduce symptoms, suffering Bereavement Care Palliative Care & Supportive Care at UNC Comprehensive Cancer Support Program Supportive Care Consultation Service UNC Palliative Care Program Palliative Care Consultation Service Schwartz Rounds Comprehensive Cancer Support Program Mimi Alvarez Stephen Bernard Pam Durham Sandi Jarr Donald Rosenstein Tina Shaban Diane Shaw Aimee Shea Elizabeth Sherwood Joanne Sroczynski John Valgus Christine Walko Palliative Care Walter (Chip) Baker Stephen Bernard Tony Caprio June Dixon Laura Hanson Renae Stafford Gary Winzelberg Supportive Care Consultation Service Stephen Bernard Sandi Jarr John Valgus Chris Walko UNC Schwartz Rounds Fran Collichio Theresa Raphael-Grimm UNC Palliative Care Consults – New Patients Served New Patients Served: 2002 – 47 patients 2003 – 110 patients 2004 – 142 patients 2005 – 143 patients 2006 – 220 patients 2007 – 192 patients (total visits = 551) 2008 – est. 325 patients (total visits = 870) UNC Palliative Care Consults by Service - 2007 4% 2% 2% 3% 2% Family 6% Geriatrics Hem/Onc 6% Surgery 29% Cardiology 5% MICU Renal 8% Pulmonary Hospitalist Infectious Dx Psych 13% 20% Neurology UNC Palliative Care Consults – Disposition 2007 3% 10% 30% Died 6% Home Home Hospice 7% Inpatient Hospice SNF Hospice SNF Signed off 22% 22%