Focused on the Big picture

Transcription

1 Focused on the Big picture Tamara M. Shearrow, MSN, NP-C, ACHPN Palliative Care Services Winchester Medical Center The presenter has no conflicts of interest to disclose.

2 Objectives Understand how palliative care supports patients/families at any stage of a serious illness. Overview of current status of Palliative Care Service at VH/WMC. Identify effective communication techniques when discussing difficult topics with patients/families.

3 Metastatic ovarian cancer Pain, nausea/vomiting, appetite decline, weight loss, ascites There is nothing more we can do. Geneva s story

4 MISUNDERSTOOD?

5 Palliative Care Is a BUZZ word End of Life Care Hospice When there is nothing more to do When no more treatments available

6 Palliative Care Hospice Ideally begins at the time of diagnosis of a serious illness No life expectancy requirement Complements curative care Expenses are covered by philanthropy, fee-for-service, direct hospital support Life expectancy < 6 months Patient/family chooses NOT to receive aggressive, curative care Focus is comfort versus cure Covered by Medicare, Medicaid, and most private insurers For pediatric patients, care is provided through mandates from the ACA.

7 Palliative Care is Specialized, interdisciplinary care Seeking to Improve comfort and quality of life At any stage of A serious illness By addressing Symptoms, communication, and transitions.

8 THE TIMING OF PALLIATIVE CARE Treatment to modify disease Risk-reduction treatments Bereavement 6m Diagnosis (serious illness) Death Palliative interventions to improve comfort and/or quality of life

9 Primary Palliative Care Palliative care provided by health care professionals who are not specialists nor certified in palliative care. All clinicians need expertise in the assessment of patient symptom burden, functional status, and quality of life, and in the development of a palliative treatment plan that is consistent with patient and family needs and preferences.

10 Specialty Palliative Care Palliative care that is delivered by health care professionals who are palliative care specialists, such as physicians who are board certified in this specialty; palliativecertified nurses; and palliative care-certified social workers, pharmacists, and chaplains.

11 Palliative Care Service Specialty Palliative Care Team Grace Brooke Huffman, MD, Medical Director Tamara M. Shearrow, NP Rachel Schwartz, LCSW Comprehensive and Collaborative Care Services Chaplains Integrative Medicine Child Life Coordinator

12

13

14 Key Aspects of Palliative Care Expert pain and symptom management Intensive communication with patient and family Assists with coordination of care across settings

15 Introducing Mr. B

16 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. 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 & Goals of Medicine 1982; 306: Eric J. Cassell, MD NEJM

17 Quality of Life Model Addresses Multi-dimensional Care Physical Well-Being & Symptoms Functional Ability Strength/Fatigue Sleep & Rest Nausea Appetite Constipation Pain Psychological Well-Being Anxiety Depression Enjoyment/Leisure Pain Distress Happiness Fear Cognition/Attention Social Well-Being Finances Caregiver Burden Roles & Relationships Affection/Sexual Function Appearance QOL Spiritual Well-Being Hope Meaning Suffering Religiosity Modified from Ferrell, B.R., & Grant, M. (2000). Quality-of-life model. Duarte, CA: City of Hope National Medical Center.

18

19 The National Consensus Project for Quality Palliative Care definition is to prevent and relieve suffering, and to support the best possible quality of life for patients and families, regardless of the stage of disease or the need for other therapies.

20 8 Domains of Clinical Practice Guidelines 1: Structure & processes of care 2: Physical aspects of care 3: Psychological & psychiatric aspects of care 4: Social aspects of care 5: Spiritual, religious, & existential aspects of care 6: Cultural aspects of care 7: Care of the patient at the end of life 8: Ethical & legal aspects of care

21 Clinical Practice Guidelines for Quality Palliative Care Goals 1- Promote quality & consistency 2- Encourage continuity of care 3- Facilitate Collaboration

22 A powerful therapeutic tool Communication Nessa Coyle

23 Communication Effective Empowers patients & families with a sense of control Reduces uncertainty & provides a basis for action Creates an environment of safety, trust & hope Strengthens the patient/nurse relationship Ineffective Can increase anxiety, impede action, extinguish hope, and lead to diminished sense of personal dignity as well as feelings of abandonment Can cause more distress & suffering for patients and families

24 Meet Brian! Focus on living life to the fullest each & everyday!

25 Dying is nothing to fear. It can be the most wonderful experience of your life. It all depends on how you have lived. Elisabeth Kubler-Ross Ekrfoundation.org/quotes

26 Questions?