what is a good death? by ashley shreves
TRANSCRIPT
What is a good death?SMACC
June 25, 2015
Ashley Shreves, MDAssistant Professor
Department of Emergency MedicineBrookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mt. Sinai
Which looks like “good” dying?
What’s most important to patients facing death?
Steinhauser JAMA 2000
Don’t patients want to live forever?
n = 226Advanced illnesses
Fried N Engl J Med 2002
What’s most important?
Non-medical >>> medical
Quality of life >>> quantity of life
Outcomes >>> treatments
Are we good with the non-medical?
Teno JAMA 2005
Quality vs Quantity?Focused on resuscitation and life-prolongation
Spectacular deaths: exciting and prioritized
“Subtacular” deaths??
Care Poor Forgotten
about
Neglected
Stuck in a corner and left there
A lower class citizen in regards to
EM
Bailey Ann Emerg Med 2010
Outcomes?Time spent
1 min
Content of conversationDescriptions of CPR
Outcomes?Not mentioned
Want to do better?
Palliative Care
Type of care
Improve quality of life/relieve suffering
Serious/advanced illness
Multidisciplinary team approach
Hospice
System of care
Improve quality of life/relieve suffering
Terminal illness
Multidisciplinary team approach
Mt. Sinai Palliative Care TeamDoctor
Nurse Practition
er
Social Worke
rChaplain
Art therapi
st
Massage
therapist
Yoga therapi
st
Nurse
Patient &
Family
What do we do?
COMMUNICATION
COMMUNICATION
COMMUNICATION
What happens?Medical decisions changeQuality of life improvesSymptom management improvesDepression decreasesLife often extended
Costs decrease
Volandes BMJ 2009Temel N Engl J Med 2010
Teno JAMA 2004Connor J Pain Symptom Manage 2007
Morrison Arch Int Med 2008
When is dying bad?
WHEN IT’S ABOUT YOU
When is dying good?
WHEN IT’S ABOUT THEM
How do patients get the good death?
PALLIATIVE CARE & HOSPICE
If not available
LEARN COMMUNICATION SKILLS