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End of Life

End of Life

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End of Life

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  1. End of Life at the what every health professional should know about palliative care Toby Campbell, MD MSCI

  2. Objectives • What is palliative care? • Communication strategies • family meetings • goals of care • transitions • difficult situations

  3. http://www.theonion.com/content/news/world_death_rate_holding_steady_athttp://www.theonion.com/content/news/world_death_rate_holding_steady_at

  4. Existential What is Palliative Care? Spiritual Social Psychological Physical

  5. OurCore Skills Care of the Dying Advanced Care Planning Complica-tions of Therapy Communi-cation Symptom Control • Psycho-social

  6. PM&R Internal Med Psychiatry OB/GYN ER Medicine Family Med Surgery Neurology Anesthesiology Radiology Pediatrics Multi-disciplinary specialty

  7. Survival Curve: Disease Normal Population % survival Disease Time

  8. Cure Normal Population % survival Cure Time

  9. LifeProlongation Normal Population % survival Prolongation of survival Time

  10. Palliative Care Normal Population % survival Palliative Care Time

  11. Intentions of Treatment Palliative Curative

  12. Traditional Model of Cancer Care Standard Cancer Care Hospice Bereavement 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

  13. Modern Model Traditional Care Focus of Care Hospice Palliative Care Symptom Burden 6-Month Prognosis Death Diagnosis Time  Campbell TC et al Semin Intervent Radiol 2007

  14. Does Palliative CareMatter?

  15. Transfers to PCU

  16. Oncology Unit on the Oncology or Palliative Care?

  17. Other16% Lung26% GU15% GI26% Breast17% 84% “Big 4”

  18. 4.7 months 27% 1 year survival

  19. Difficult Conversations Oh No! A communication toolkit SPIKES NURSE I Wish Hope for the Best, Plan for the worst Outcome Oriented Make a Recommendation

  20. Setting the Scene

  21. Understand their Perception

  22. Get anInvitation

  23. Share Your Knowledge

  24. Silence

  25. Empathic Statements • NURSE • Naming • Understanding • Respecting/Praising • Supporting • Exploring • I Wish Statements

  26. Summarize Strategize

  27. Transitions in Care Tough Times Goals Transitions Heroes Denial

  28. Where are we going?

  29. 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

  30. Transitions in care Fix Knowledge barriers Orient to Outcomes Respond toEmotion

  31. The 11thHour Hero

  32. I want everything done

  33. Thank You Toby Campbell 608-206-9109 (m)