The Pulse of Palliative Care

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Bartholomew Davis
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1 The Pulse of Palliative Care Marianne E. Hess MSN, RN, CCRN-K George Washington University Hospital

2 Disclosures: I do not have any relevant financial interest to disclose. I have no commercial interest in any entities producing health care products.

3 Objectives Define Palliative Care Discuss three misconceptions of Palliative Care Discuss Palliative Care in relation to the care of the cardiac patient

4 (Pinterest, Monsters, Inc. Pixar)

5 What is palliative care? Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with lifethreatening 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. (WHO, 2019)

6 Specifically, palliative care Uses a multidisciplinary team approach to Provides relief from pain and other distressing symptoms Integrates the physical, emotional, coping, psychological and spiritual aspects of patient care Is applicable: Early in the course of illness In conjunction with other therapies (e.g. chemotherapy or surgery) and modalities Offers a support system to help the family cope during the patient s illness and in their own bereavement (WHO, 2019)

7 YOU are a bridge

8 Key Aspects Prevention and relief of suffering Symptom management Involves patient and their family in dealing with a serious or chronic illness (Munro & Savel, 2018) Embraces the subjective rather than the objective. (BJ Miller, 2016)

9 Goal Not to hasten death, but to enhance the quality of life

10 Who Needs Palliative Care? About half of all Americans live with at least one chronic illness Increase in severity, frequency, and complexity of illness with age 9 out of 10 Americans over the age of 65 have at least one chronic disease 77% have two or more chronic diseases (CSU, 2019)

11 Conditions such as: ALS (amyotrophic lateral sclerosis) Alzheimer s Disease Cancer Solid organ & hematologic Cardiovascular CHF COPD Drug resistant tuberculosis Kidney failure Dementia Diabetes HIV/AIDS Huntington's Disease Liver Disease Multiple Sclerosis Parkinson's Disease Rheumatoid Arthritis Pulmonary Fibrosis Sickle Cell Stroke

12 World Health Organization (WHO)

13 (WHO, 2019)

14 In fact, In 2014, the WHO approved a resolution that all members must improve access to palliative care as a core component of healthcare systems Palliative care can be for all ICU patients (Munro & Savel, 2018)

15 Why? Palliative care results in Improved quality of life Decreased length of stay Decreased cost (Munro & Savel, 2018)

16 CENTER TO ADVANCE PALLIATIVE CARE

17 How? Physical symptom management Fatigue Nausea Anorexia Insomnia

18 How? Symptom management Pain 67% of patients with cardiovascular disease or COPD will experience moderate to severe pain at the end of their lives Opioids, music therapy, massage Dyspnea Positioning, spacing activities, fan Thirst Oral swabs, lip moisturizer (Munro & Savel, 2018)

19 How? Emotional, coping, and social care For patient, family and staff Practical assistance Spiritual well being (Medline, 2018)

20 How? Coordination of healthcare team Prevent working in silos Pulls whole picture together (Harkins, 2019)

in it Licensed independent practitioners (MD, PA, NP)

21 Who provides palliative care? Interdisciplinary team Any health care provider May specialize in it Licensed independent practitioners (MD, PA, NP) Registered nurse Registered dietitians Social workers Pharmacists Psychologists Massage therapists Chaplains

22 Where? Hospitals Home care agencies Cancer centers Long-term care facilities Only 57% of hospitals have palliative care teams (CSU, 2017) Seen more in urban areas than in rural areas (CSU, 2017)

23 Misconceptions Doesn t mean patient will die sooner Patients with non-small cell lung cancer lived 11.6 months with palliative care vs. 8.9 months without (Orwig, 2018) Doesn t have to be only initiated at end of life (Munro & Savel, 2018)

24 Difference between Palliative Care and Hospice Care Palliative Care Provides comfort Can begin at diagnosis, and at the same time as treatment Hospice Provides comfort Begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness Often offered only when the person is expected to live 6 months or less (Medline, 2018)

25 Misconceptions: Patients and families Decisions CAN be changed Not written in stone Should be reviewed at least yearly

26 Misconceptions: Patients Many patients want to discuss the topic of palliative care 87% of elderly patients support having end of life conversations with their physician, but only 27% have had it (Orwig, 2018)

27 Misconceptions: Healthcare professionals We have to do everything Use the technology Buy-in regarding the benefits of palliative care Would you be surprised if the patient was still alive in 6 months? I gave them their last pain medication, so I killed them Intent to treat

Effective communication is essential Patient and family

28 Barriers Healthcare illiteracy Patient and family may not be on the same page Utilize non-verbal communication Effective communication is essential Patient and family may be in a state of shock Families may not abide by patient s wishes

29 What to say to a patient Identify their priorities and values Ask fears and bottom line (Orwig, 2018) What is their concern What is their goal What is most important (Medline, 2018) Advanced Directive Photo: nbc/google images

30 Case Study

31 Conclusion Palliative care is crucial to the well-being of patients and their families, throughout the patient s trajectory of illness (Munro &Savel, 2018)

32 Questions? Thank you for your attention Contact information: Marianne E. Hess MSN, RN, CCRN-K George Washington University Hospital

33 References: Denvir, M., Murray, S., & Boyd, KJ. (2015). Future care planning: A first step to palliative care for all patients with advanced heart disease. Heart, 100, McIlvennan, C. & Allen, L. (2016). Palliative care in patients with heart failure. British Medical Journal, 352. doi:10:1136/bmj.1010 Munoz-Mendoza, J. (2015). Competencies in palliative care for Cardiology Fellows. Journal of the American College of Cardiology, 65(7), Munro, C. & Savel, R. (2018). Aggressive care and palliative care. American Journal of Critical Care, 27(2), Orwig, S. (2018). Barbara Bush s embrace of comfort care has sparked a national dialog. Advisory Board. Ouimet, K. & Kazanowski, M. (2015). Overcoming barriers to palliative consultation. Critical Care Nurse, 35(5), Riegel, B. & Kimmel, S. (2018). Palliative care: Is now the time?. European Journal of Cardiovascular Nursing, 17(6), Slawnych, M. (2018). New dimensions in palliative care cardiology. Canadian Journal of Cardiology, 34, Westlake, C. & Smith, C. (2015). Nursing concerns with palliative care and at end of life in patients with heart failure. Nursing: Research and Reviews, 5,

34 Websites nity/what-is-palliative-care/ ons/ htm

What You Need To Know About Palliative Care. Natalie Wu Moy, LCSW, MSPA RUHS Medical Center Hospital Social Services Director

What You Need To Know About Palliative Care Natalie Wu Moy, LCSW, MSPA RUHS Medical Center Hospital Social Services Director None of the faculty, planners, speakers, providers, nor CME committee members