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End of Life. at the. what every health professional should know about palliative care. Toby Campbell, MD MSCI. Objectives. What is palliative care? Communication strategies family meetings goals of care transitions difficult situations. - PowerPoint PPT Presentation
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End of Lifewhat every health professional should know about palliative care
at the
Toby Campbell, MD MSCI
Objectives
• What is palliative care? • Communication strategies
– family meetings– goals of care– transitions– difficult situations
http://www.theonion.com/content/news/world_death_rate_holding_steady_at
Physical
Spiritual
Social
Existential
Psychological
What is
Palliative Care?
Communi-Communi-cationcation
Advanced Advanced Care Care PlanningPlanning
Complica-Complica-tions of tions of TherapyTherapy
Psycho-Psycho-socialsocial
Care of the Care of the DyingDying
Symptom Symptom ControlControl
Our
Core Skills
OB/GYN
Pediatrics
Neurology
Psychiatry
Radiology
Surgery
PM&R
ER Medicine
Anesthesiology
Family Med
Internal Med
Multi-disciplinaryspecialty
Survival Curve: Disease
Normal Population
Disease
%survival
Time
Cure
Normal Population
%survival
Time
Cure
Life Prolongation
Normal Population
%survival
Time
Prolongation of survival
Palliative Care
Normal Population
Palliative Palliative CareCare
%survival
Time
Intentions of Treatment
Palliative
Curative
Traditional Model of Cancer Care
HospiceStandard Cancer Care
Bad News Transitions to EOL
*Emanuel LL, Ferris FD, von Gunten CF, Von Roenn JH. EPEC-O: Education in Palliative and End-of-Life Care. Oncology, p. P2-7
Bereavement
Modern Model
Traditional Care
Palliative Care
Hospice
Death6-Month PrognosisDiagnosis
Focus of
Care
Time
Symptom Burden
Campbell TC et al Semin Intervent Radiol 2007
Does
Palliative Care Matter?
Transfers to PCU
Oncology Unit
Oncology or Palliative Care?Oncology or Palliative Care?
on the
Lung26%
GI26%Breast
17%
Other16%
GU15%
84%
“Big 4”
4.7 months4.7 months
27% 1 year survival27% 1 year survival
Difficult ConversationsOh No!
A communication toolkit•SPIKES•NURSE•I Wish•Hope for the Best, Plan for the worst•Outcome Oriented•Make a Recommendation
Setting the Scene
Understand their Perception
Get an Invitation
Share Your Knowledge
Silence
Empathic Statements• NURSE
– Naming– Understanding– Respecting/Praising– Supporting– Exploring
• I Wish Statements
Summarize
Strategize
Transitions in CareGoals TransitionsHeroesDenial
Tough Times
Where are we going?
Goal Setting
• Hope for the Best, Plan for the Worst• Avoid the useless:
– “Do you want everything done for her?”– “Should we restart her heart if it stops?”
• Make a recommendation
Transitions in care
Fix Knowledge barriers
Orient to Outcomes
Respond toEmotion
The 11th Hour Hero
I want everything done
Thank You
Toby Campbell608-206-9109 (m)
