Palliative CareKenneth Morgan Sauer, MD

Baptist Health SystemsJune 3, 2015

Palliative CareThe United States is expected to experience rapid aging of the population over the next few decades. By the year 2050, the number of Americans over age 65 is expected to grow to 88.5 million, up from 40.2 million in 2010--more than double.

As adults age, their medical conditions become less responsive to curative treatment, and they also experience significant physical and cognitive decline. This is often why they require long-term care.

Objectives• Understand the principles of palliative care and

how it differs from traditional models• Understand the importance of establishing

and fulfilling goals of care as a critical element of palliative care

• Describe the common physical and psychological symptoms at end-of-life and ways to address them using a palliative approach

• Describe ways to recognize the final hours and how best to support the patients and families/loved ones

What is Palliative Care?

The World Health Organization (WHO) defines palliative care as 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.”

UnderstandingPalliative Care

• Palliative care differs from traditional care in that it typically does not rely heavily on invasive tests or procedures or other diagnostic methods that are aimed at finding a cause or cure for a certain symptom or medical condition!

• Rather than curing disease, palliative care focuses on alleviating discomfort.

• It’s all about patient COMFORT!

Palliative Care vs.Hospice Care

Palliative care is similar to hospice

Both share the same philosophy

Palliative care may be utilized at any time during treatment

Palliative Care vs.Hospice Care

Hospice usually delivered by a hospice care team vs. traditional team

Hospice is a Medicare/Medicaid/private insurance benefit

Hospice has regulations regarding care and eligibility.

Palliative Care vs.Hospice Care

Palliative care does not have regulatory restrictions

Hospice is a branch of palliative care.

All hospice is palliative care, but palliative care is much more than just hospice.

Palliative Care

Relief from pain and distress

Regards dying as a normal part of the life cycle

Does not hasten or postpone death

Uses biopsychosocial model of care

Team approach for pt/family needs

Support for caregiver stress and bereavement

Who Provides Palliative Care?

Palliative care is not just medical care or nursing care

All team members play a vital role in palliative care

All team members must be supportive of this approach to care.

Palliative Care Team

Nurse- primary provider, caries out most aspects of care plan. Monitors patient’s physical condition, symptoms, and response to interventions

Nurse Assistant- helps identify needs and response to intervention. Delivers non-medical palliative interventions

Palliative Care Team

Social Worker- helps patients/families plan EOL issues: finances, funeral, and legal arrangements. Provide support, identify & address emotional needs.

Chaplain- spiritual/emotional support to patients, families, AND STAFF!!!

Palliative Care Team

PT/OT- therapies and supportive devices for max comfort. Caregiver education to assist with care.

MD/DO/APN/PA- orders interventions, prognostication, medical diagnoses, directs the team approach

Palliative Care Team

Recreation therapist- helps design pleasure activities, assist with getting the most fun out of life

Dietician- assist with meal planning, shopping instructions

Pharmacist- evaluate medications and interactions (including diet and OTCs).

Developing The Palliative Care Plan

Agreed by all team members and propelled by nursing to address the following:

Goals of Care

Physical Symptoms

Psychological Symptoms

Family Needs and Concerns

Liberalized Restrictions

Goals of CareClarify palliative care does not mean withdrawing care

Frame a plan to meet goals of care

Revisit plan frequently with team & caregivers/family

Complete advanced directives

Know various types

Understand the family may be overwhelmed.

Symptoms of End of LifePain: Common. May be complex

Respiratory: dyspnea, cough, wheeze

GI: Nausea, constipation, aspiration

Psychological: Depression, anxiety, hallucinations, delirium, decreased LOC

Spiritual: Crisis of faith

Interventions

Long acting + PRNs vs. PRNs (esp pain)

Oxygen, inhaler vs. nebulizer, diuretics, steroids

Anti-nausea meds, bowel stimulants vs. osmotic agents

Anti-depressants, anxiolytics

Non-pharmacologic therapies

Addressing Spiritual Needs

Offer religious music, writings, or icons

Arrange for spiritual leader visit

Facilitate rituals

Assist with funeral arrangements

DO NOT WAIT UNTIL THE LAST MINUTE!!!!!!

Cultural Considerations

Most people have more than one culture

Manifested through values, beliefs, customs, and behaviors

Affects decision making, views on death, & many other aspects of care

Race, ethnicity, religion, and lifestyle contribute to culture

Preserving Dignity

Cleanliness and oder control

Bathing and grooming

Mouth and nail care

Clothing and bedding

Maximize independence

The Final Hours

Pain and noisy breathing

Attending to symptoms and hygeine

Limited food/fluid intake

Maintaining personhoodTalk to resident appropriately

Educate family

Thank You!Any Questions?