Transcript Beverly JeffsSteele

The Case for
Palliative Care
How Americans died in the past
 Early 1900s
 average life expectancy 50 years
 childhood mortality high
 adults lived into their 60s
 Prior to antibiotics, people died quickly
 infectious disease
 accidents
 Medicine focused on caring, comfort
 Sick cared for at home
 with cultural variations
The Eperc Project
Medicine’s Shift in Focus
 Marked shift in values, focus of North American society
“death denying”
value productivity, youth, independence
devalue age, family, interdependent caring
 Death “the enemy”
organizational promises
sense of failure if patient not saved
Medicine’s Shift in Focus
 Science, technology, communication
 Potential of medical therapies
 fight aggressively against illness, death
 prolong life at all cost
 Improved sanitation, public health, antibiotics, other new
therapies
 increasing life expectancy

2010 avg 78.7 years
We Hope to
Die in my sleep
Die suddenly
The Reality
 90% of us will die after a progressive decline from chronic
illness.
Results
More than 70% of Americans say they would prefer to die
at home
25% of deaths occur at home
(Robert Wood Johnson Foundation)
From This
The Demographic Imperative
Chronically Ill, Aging Population is growing
 The number of people over age 85 will double to 10 million by
the year 2030
 People living longer with chronic disease.
 The 23% of Medicare patients with > 4 chronic conditions
account for 68% of all Medicare spending
 Aggressive treatment at end of life often leads to a decrease in
quality of life for patients and their families
 Significant association between increased cost and lower
quality of death in the final week of life
 9000 Patients with life-threatening illness, 50% died
within 6 months
 Half of patients had moderate-severe pain, >50% in the
last 3 days of life.
 38% of those who died spent >10 days in ICU, in a coma
or on a ventilator
Why
 Difficult to discuss
 “I’ll die in my sleep”
 Magical thinking “If I talk negatively, it will happen”
 Seen as “giving up”
 Family doesn’t want to discuss
 Some would argue that in general we have lost faith in
transcendent life
 Advance care planning consists mostly of funeral
arrangement
 Most people say they want to discuss their values and
wishes about end of life care with their physician—and
they expect the physician to bring up the topic
 Physicians feel patients will have difficulty discussing
these sensitive issues
 Most people are never asked about their wishes
 Only 10-15% of Americans have Advance Directives
Intro to Palliative Care
 "The relief of suffering and the cure of disease must
be seen as twin obligations of a medical profession
that is truly dedicated to the care of the
sick. Physicians’ failure to understand the nature of
suffering can result in medical intervention that
(though technically adequate) not only fails to relieve
suffering but becomes a source of suffering itself."
 The Nature of Suffering and the Goals of MedicineEric Cassell
Intro to Palliative Care
Medical code of ethics and clinical guidelines explicitly
indicate the importance of respecting patients’ rights, goals
and values, as well as good communication, advance care
planning, and recognizing when continuing treatment is
more harmful than beneficial.
 Patient and family centered care
 Optimizes quality of life by anticipating, preventing and
treating suffering
 Throughout the course of illness
 A holistic approach that includes physical, intellectual,
emotional, social and spiritual needs
 Facilitates patient autonomy, provides information and
choice
Traditional Care Model
Curative Care
Hospice
Care
<------------------Disease Process –-------------
Conceptual shift for Palliative Care – ever increasing presence of
Palliative Care throughout the disease process
.
 Pain and symptom control
 Avoid inappropriate prolongation of the dying process
 Achieve a sense of control
 Relieve burdens on family
 Strengthen relationships with loved ones
 Closure – I love you and goodbye
What do Patients and Families
Want
 Loved one’s wishes honored
 Inclusion in decision process
 Support/assistance at home
 Honest information
 Personal care needs met (bathing, etc.)
 To be listened to
 Privacy
 To be remembered after the death
Palliative Care Services Provides:




Compassionate care
Management of distressing symptoms
Clarification of treatment options
Improves communication between patients and
caregivers
 Assists with establishing advance directives
 Help patients to develop their goals of care
 Time to listen
 Goals of Care
 Family discussions to determine patient’s wishes – What is
important to the patient and their family
 Determine setting for care
 Provide information re: Hospice as appropriate
 Evaluate support systems
 Evaluate spiritual needs
 Provide information regarding treatment options
 Talk about what happens at the end of life
 Assist patients and families with Advance Directives
 Symptom Management
 Pain
 Nausea
 Constipation
 Anxiety
 Shortness of Breath
 Agitation
 Depression
Palliative Care Assists With
Redefining Hope
 I hope treatments will be explained and I will be included
in treatment decisions
 I hope my life has meaning
 I hope I can still meet some of the goals that are
important to me
 I hope I can get help with the practical things I need to do
before I die
Palliative Care Assists With
Redefining Healing
 Healing fractured relationships
 Completing unfinished business
 Taking a trip
 The Bucket List
 Maintain Dignity
 Relief of distressing symptoms
 Help navigating a complex medical system
 Understanding the plan of care
 Coordination and control of care options
 Allowing simultaneous palliation of suffering along with
continued treatment
 Practical and emotional support for patients and
exhausted family caregivers
Hope for the best,
But make arrangements just in case.
Hippocratic Ethos
To cure occasionally
To relieve often
To comfort always
Please join us:
http://vote.livestrong.org/vote2012/regions/1/3
-harrison-medical-center/
&
Quality of Life Forum
Harrison Silverdale
st
May 21 at 5:30 PM
[email protected] or 744-5618