The Final Piece of a Comprehensive HPC Program. November 14, 2012

Transcription

1 The Final Piece of a Comprehensive HPC Program November 14, 2012

2 No Potential Conflict of Interest to Declare We do not currently have, nor have we had in the past an affiliation with/or financial interests in a business corporation related to tonight s presentation. Karen Fisher RN,BcSN,CHPCN,CONC Andre Moolman MBChB,CCFP

3 The Essence of Dignity you matter because you are you, and you matter to the end of your life Dame Cecily Saunders

4 Dignity Therapy? Is it something we already do? What do we call it? How do we do it, if we do it? Is it an intervention we discuss as a course of developing a care plan? Is it considered for all of our patients? How do we decide? What do the patient/family take away from what we do?

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6 Social Support Generativity Continuity of Self Care Tenor Dignity Therapy Maintenance of Pride Aftermath Concerns Role Preservation Maintaining Hope Chochinov HM. Dignity-conserving care-a new model for palliative care. JAMA.2002

7 Dignity Therapy Question Framework Are there specific things that you would want your family to know about you, and are there particular things you would want them to remember? What are the most important roles you have played in life (family roles, vocational roles, community-service roles, etc)? Why were they so important to you, and what do you think you accomplished in those roles? What are your most important accomplishments, and what do you feel most proud of? What are your hopes and dreams for your loved ones?

8 The Work of Dr. Harvey Chochinov MPCRU Brief review of publications and birth of DT Previous studies Reveal of model JAMA 2002??????

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10 Dignity Therapy Study: Phase I Trial (n = 100) (n=100) Satisfied or highly satisfied 91% Helpful or very helpful 86% Increased Sense of Dignity 76% Increased sense of purpose 68% Heightened sense of meaning 67% Increased will to live 47% Believed it had or would help their family 81% Chochinov et al. J Clin Oncol. 2005;23:

11 Dignity Model Illness related concerns Dignity Dignity conserving repertoire Social dignity inventory

12 Chochinov et al. Social Science and Medicine 2002

13 Who are YOU? It is more important to know the person who has the disease than to know what disease the person has Hippocrates

14 Who is DT for? Any palliative (px of <12 mo) or EOL patient (< 3 mo) Palliative care team Pt. who is cognitively aware Pt. and care team that views DT as an important intervention in their plan of care, i.e. one that carries therapeutic benefits Believes in its ability to enhance QOL

15 Patient Dignity Question what do I need to know about you as a person to give you the best care possible?

16 Key Elements Protocol questions introduction Tone Candidate DT Photo album

17 Tone care tenor or fragrance of care Kindness Sincerity Respectful Engaged No message from HCP client driven and centered Data supports that how the pt. perceives the HCP sees them can have a profound impact on their dignity.chochinov et al., 2008

18 Connecting the dots Tell me about What a wonderful story You said.. Great..tell me about that Anything more?

19 Photo Album Analogy imagine that we are looking at a photo album of your life. Tell me about some of the photos we would see.

20 the Document Do we NEED the document Will it change the intervention of DT? Raw to refined Removing yourself from the document Challenges Introducing the document to patient/family

21 Where do we go from Next steps Consider pilot here? Develop small scale structure that has generalizability

22 Multiple disciplines involved multiple times Introduction Process Goals Outcome Fragments of DT; disorganized; no particular goal Structured DT program

23 Structured WWDT Program

24 It was the best of times, it was the worst of times it was the age of wisdom, it was the age of foolishness it was the epoch of belief, it was the epoch of incredulity it was the season of Light, it was the season of Darkness it was the spring of hope, it was the winter of despair we had everything before us, we had nothing before us we were all going direct to Heaven, we were all going direct the other way in short, the period was so far like the present period, that some of its noisiest authorities insisted on its being received, for good or for evil, in the superlative degree of comparison only Charles Dickens, A Tale of Two Cities

25 Questions