end of life
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End of Life. at the. what every health professional should know about palliative care. Toby Campbell, MD MSCI. Objectives. What is palliative care? Communication strategies family meetings goals of care transitions difficult situations. - PowerPoint PPT PresentationTRANSCRIPT
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End of Lifewhat every health professional should know about palliative care
at the
Toby Campbell, MD MSCI
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Objectives
• What is palliative care? • Communication strategies
– family meetings– goals of care– transitions– difficult situations
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http://www.theonion.com/content/news/world_death_rate_holding_steady_at
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Physical
Spiritual
Social
Existential
Psychological
What is
Palliative Care?
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Communi-Communi-cationcation
Advanced Advanced Care Care PlanningPlanning
Complica-Complica-tions of tions of TherapyTherapy
Psycho-Psycho-socialsocial
Care of the Care of the DyingDying
Symptom Symptom ControlControl
Our
Core Skills
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OB/GYN
Pediatrics
Neurology
Psychiatry
Radiology
Surgery
PM&R
ER Medicine
Anesthesiology
Family Med
Internal Med
Multi-disciplinaryspecialty
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Survival Curve: Disease
Normal Population
Disease
%survival
Time
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Cure
Normal Population
%survival
Time
Cure
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Life Prolongation
Normal Population
%survival
Time
Prolongation of survival
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Palliative Care
Normal Population
Palliative Palliative CareCare
%survival
Time
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Intentions of Treatment
Palliative
Curative
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Traditional Model of Cancer Care
HospiceStandard Cancer Care
Bad News Transitions to EOL
*Emanuel LL, Ferris FD, von Gunten CF, Von Roenn JH. EPEC-O: Education in Palliative and End-of-Life Care. Oncology, p. P2-7
Bereavement
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Modern Model
Traditional Care
Palliative Care
Hospice
Death6-Month PrognosisDiagnosis
Focus of
Care
Time
Symptom Burden
Campbell TC et al Semin Intervent Radiol 2007
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Does
Palliative Care Matter?
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Transfers to PCU
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Oncology Unit
Oncology or Palliative Care?Oncology or Palliative Care?
on the
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Lung26%
GI26%Breast
17%
Other16%
GU15%
84%
“Big 4”
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4.7 months4.7 months
27% 1 year survival27% 1 year survival
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Difficult ConversationsOh No!
A communication toolkit•SPIKES•NURSE•I Wish•Hope for the Best, Plan for the worst•Outcome Oriented•Make a Recommendation
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Setting the Scene
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Understand their Perception
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Get an Invitation
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Share Your Knowledge
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Silence
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Empathic Statements• NURSE
– Naming– Understanding– Respecting/Praising– Supporting– Exploring
• I Wish Statements
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Summarize
Strategize
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Transitions in CareGoals TransitionsHeroesDenial
Tough Times
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Where are we going?
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Goal Setting
• Hope for the Best, Plan for the Worst• Avoid the useless:
– “Do you want everything done for her?”– “Should we restart her heart if it stops?”
• Make a recommendation
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Transitions in care
Fix Knowledge barriers
Orient to Outcomes
Respond toEmotion
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The 11th Hour Hero
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I want everything done
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Thank You
Toby Campbell608-206-9109 (m)