Palliative Care in the ICU

Transcription

1 Palliative Care in the ICU David M. Fedor, DO, FACP, HMDC Intermountain Health Care Physician Intensivist-Critical Care Medicine: MckayDee Hospital; Medical Director - Palliative Care at Mckay Dee Hospital; System Medical Director for Pailiative Care for Intermoutain Healthcare Hospice Medical Director Certified Objectives: Define the term "Palliative Care" Describe when/how Palliative Care should be used in the ICU Identify Barriers to effective utilization to Palliative Care in the ICU

2 Palliative Care and the ICU David M. Fedor D.O. FACP, HMDC Intensive Medicine Clinical Program Conference September 23, 2015

3 Who am I? Intensivist at McKay Dee Hospital Medical Director of Palliative Care at McKay Dee Hospital Intermountain Healthcare System Medical Director for Palliative Care Hospice Medical Director Certified

4 Disclosures I have nothing to disclose, declare, or admit at this time. I have no conflicts of interest. This will be free of commercial or industry bias. Person Bias will abound

5 Goals for today 1. Define the term Palliative Care 2. Discuss Palliative Care s role in the ICU 3. Identify which patients would benefit from Palliative Care in the ICU. 4. Identify the biggest barrier to Palliative Care utilization in the ICU

6 Why Palliative Care? Why talk about this today? Isn t that just part of Critical Care? We already do that every day. Not all of our patients need Hospice Statements like those above are the reason for this talk.

7 Who needs palliative care?

8 Who needs Palliative Care in the ICU Answer: EVERYONE

9 Modern End of Life=Protracted Course 85% of people in the US will experience one of these trajectories at the end of life 20% Cancer 25% Organ Failure 40% Dementia/Frailty Average American 2-4 years of disability before death

10 Palliative care comes from the word palliate, which means to ease.

11 Palliative Care Definition World Health Organization Definition: An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual needs Multidisciplinary approach that focuses on the whole patient and family Note that the unit of care is more than the patient- to include family/friends, caregivers

12 Palliative Care Language Endorsed by the Public Palliative care is specialized medical care for people with serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work with a patient's other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment.

13 PALLIATIVE CARE VS HOSPICE All of hospice is palliative care, but not all of palliative care is Palliative Care Hospice hospice

14 Why Palliative Care is Important to Improving Value in Health Care Improves patient quality/length of life Reduces pain, depression and other symptoms; in several studies prolongs life Improves family satisfaction and well-being Reduces resource utilization and costs.and does so for the sickest 5%-10% of the population driving over half of total healthcare costs.

15 Palliative Care Teams Address 3 Domains 1. Physical, emotional, and spiritual distress 2. Patient-family-professional communication about achievable goals for care and the decision-making that follows 3. Coordinated, communicated, continuity of care and support for practical needs of both patients and families across settings

16 Palliative Care Improves Value Quality improves Symptoms Quality of life Length of life Family satisfaction Family bereavement outcomes Care matched to patient centered goals Costs reduced Hospital costs decrease Need for hospitalization/icu decreases

17 OLD VS NEW APPROACH Life Prolonging Care Medicare Hospice Benefit Old Disease Progression Life Prolonging Care Palliative Care Hospice Care New Diagnosis of serious illness Death

18 A Palliative Care Trajectory May represent decades E n d of L i f e Care Diagnosis of a Potentially Death Event Active Life-Limiting Illness, Dying Condition To Include: Remission(s) (24-72 hrs) Worried Wellness Cautiously Cured (Anxious) Survivorship Chronically well/ill

19 Curative and Palliative Approaches to Care throughout a Critical Illness. Cook D, Rocker G. N Engl J Med 2014;370:

20 ICU Patients and Families Define High-Quality ICU Palliative Care

21 Key Issues for Palliative Care in ICU Articulate clear definition of PC in this setting Strike right balance of generalist/specialist PC Overcome clinicians and families fear, distrust Identify shared goals across the CC/PC teams

22 ICU Palliative Care Defining Elements Alleviation of distressing symptoms Alignment of plan with preferences Communication of treatments and care goals Support for families and caregivers Continuity of care across transitions Provided with curative/life extending treatments

23 How do we do this? How can we get better Palliative Care in the ICU? Multiple approaches Consultative Embedded Combination Approach depends on resources and needs

24 Combined Model (Most common) Basic palliative care components embedded in ICU routines, systems; Specialty P.C. for refractory symptoms or situations (Family meetings, Goals of care) This is not static. Will change with time. Get involved with your local Palliative Care team to determine what works best for your specific region/hospital

25 Why is this changing now? Why the spotlight on Palliative Care? Multiple reasons We are maturing as a society. Both in terms of age, and in terms of thinking People are more involved in their care. Financial

26 Generalist Palliative Care? Most Palliative Care is performed by generalists. Any clinician who works directly with patients can be considered a generalist in palliative care. Specialists are slightly different All most of us need is a little focused training.

27 Barriers Biggest Barrier to Palliative Care in the ICU is the term: Palliative Care. Palliative Care/Hospice Confusion from Patients, Providers, Nurses etc.. Most common issue. This patient doesn t need Hospice This patient is going to have a good recovery

28 How can we get better? Fortunately, Palliative Care is in the spotlight Many resources available. ACCP, SCCM IOM report on end of life care UCOPE-Utah Certificate for Palliative Education Training Generalists for Palliative Care. IPAL-ICU Improving Palliative Care in the ICU

29 ICU Staff This is where we come in. Champion Palliative Care Educate, educate, educate! Generalists are going to be the main drivers of Palliative Care in the Future.

30 Intermountain and Palliative Care Very important part of Intermountain s future plans. We have a growing inpatient and outpatient palliative care service at multiple IHC hospitals and clinics Goal is comprehensive inpatient and outpatient services. Robust generalist palliative care education.

31 Take Homes Everyone in the ICU needs Palliative Care Palliative Care is not Hospice ICU staff can change the perception of Palliative Care Training and education is available Palliative Care is holistic care

32 I m finished my rambling Thank you for your attention Questions? Comments? Hopes? Votes? Dreams? Ideas? david.fedor@imail.org

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