Palliative Care: Expanding the Role Throughout the Patient s Journey. Dr. Robert Sauls Regional Lead for Palliative Care

Transcription

1 Palliative Care: Expanding the Role Throughout the Patient s Journey Dr. Robert Sauls Regional Lead for Palliative Care 1

2 Faculty/Presenter Disclosure Faculty: Dr. Robert Sauls MD, with the Mississauga Halton/Central West Regional Cancer Program: Primary Care Oncology Day Relationship with Commercial Interests: No affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization 2

3 Slide Title Points o Sub points 4

4 Temel, et al 2010 Newly diagnosed metastatic nonsmall cell lung cancer; ECOG 0-2 Randomized o Intervention Assessment by member of palliative care team MD or APN at entry Assessed monthly by the team member until death 1-8 visits (average 4) o Control Group Usual care 5

5 Temel, et al, 2010 PROs (Patient Reported Outcomes) o Improved QOL at 12 weeks (multiple measures: P = ) o Reduced depression (16% vs 38%; P = 0.01) Health Care Utilization o Reduction in aggressive care * (33% vs 54%, P=0.05) o Improved documentation of resuscitative preference (58% vs 23%, P=0.05) * Chemotherapy in last 14 days; no or late hospice referral 6

6 Temel, et al, 2010 Improved survival (11.6 vs 8.9 mos, P=0.02) 7

7 He s Palliative Now Model 8

8 She Would Benefit From Palliative Care Model

9 Key Priorities Symptom management for all patients Identifying and caring for patients with advancing illness o Patients likely entering the last year of life 10

10 SYMPTOM MANAGEMENT 11

11 The Tools Edmonton Symptom Assessment Scale (ESAS) Symptom Management Guides (Cancer Care Ontario) 12

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13 Symptom Management Guides Pain Depression Nausea & Vomiting Loss of Appetite Diarrhea Altered Taste Dyspnea Anxiety Delirium Constipation Fatigue Oral Care (infection, mucositis, dry mouth) 14

14 EARLY IDENTIFICATION OF PATIENTS WITH PALLIATIVE NEEDS 15

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16 General Indicators of Decline Advancing disease unstable or deteriorating; complex symptom burden Decreasing response to treatments; decreasing reversibility No further disease modifying treatment Declining functional status (PPS, PRFS) Recurrent crises;unplanned hospital/er visits Comordidity 17

17 Specific Indicators - Cancer Stage IV (metastatic disease) or poor prognosis disease Progressive disease Decreasing response to treatment No further treatment available Declining functional status (PPS, PRFS, ECOG) Sentinel events hospital admissions, ER visits Preference for palliative approach 18

18 BROACHING PALLIATIVE CARE IT S NOT JUST ABOUT DYING 19

19 Key objectives Symptom Management Planning care now and for the future o Quality of life o End of life Plan for the best, prepare for the worst Walking two pathways 20

20 What do you understand about your illness? What have you been told about your illness? 21

21 PRIMARY CARE & PALLIATIVE CARE 22

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23 Establishing a Collaborative Model Palliative Care Triage in the Cancer Centre o Patient identification o Assessment of needs complexity o Communication with family physician o Establish a collaborative plan 24

24 Assembling the Team Family Physician Cancer Centre o Oncology physicians & nurses o Palliative Care physicians & nurses o Psychosocial Oncology social work, psychology, dietician CCAC Palliative Care Services o Care Coordinator o Community Nurse o Advanced Practice Nurses in Palliative Care Hospice 25

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