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PALLIATIVE CARE UPDATE

This presentation by Dr. Sally Sample, Medical Director at Vitas Innovative Hospice, focuses on the significance of palliative care, emphasizing its holistic approach to treating chronically ill patients. The talk encourages healthcare providers to engage in important conversations about end-of-life options, directing attention towards minimizing suffering and the implications of treatment decisions. Through historical perspectives and current legislation, Dr. Sample aims to dispel the stigma surrounding discussions of death and dying, underscoring that providing palliative care is not a failure, but a compassionate choice.

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PALLIATIVE CARE UPDATE

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  1. PALLIATIVE CAREUPDATE BY SALLY SAMPLE, MD

  2. LIFE IS SHORT

  3. Employment Affiliations Medical Director Vitas Innovative Hospice, Sacramento Valley Medical Director End-of-life pilot for Medi-Cal administered by APS Healthcare starting 2010 Hospitalist Woodland Memorial Hospital

  4. FINANCIAL DISCLOSURE • I have no financial gains or incentives for this talk

  5. GOALS • To have everyone thinking of Palliative Care when dealing with their chronically ill patients • To encourage discussions with those patients • To realize that just because we CAN do a treatment doesn’t mean we SHOULD • To remember: Everyone dies--it is not a failure

  6. SUMMARY • DEFINITIONS • HISTORY stigma of death and dying • PC Today and the HCP role • Some relevant references to the literature • Legislation • National and State Trends

  7. PC DEFINITIONS --Care of the entire person and family--physical, psychological, social and spiritual • Care to minimize Suffering • Cassell,E.J.(1982).The nature of suffering and the goals of medicine. NEJM 306(11),639-45

  8. PC DEFINITIONS

  9. GRAPH

  10. HISTORY

  11. HISTORY • PALLIATIVE CARE: OLDEST FORM OF MEDICINE • NEWEST SUBSPECIALTY

  12. PALLIATIVE CARE 19th century and before: approach to illness involved family, church, very few life prolonging treatments family at death bed dying was part of life

  13. PALLIATIVE CARE • 19th century and before • Health Care Provider Role: Diagnosis and Prognosis • Whether the patient would succumb

  14. PALLLIATIVE CARE • Civil War changed nature of death and dying--no longer family at death bed • This Republic of Suffering. By Drew Gilpin Faust

  15. PALLIATIVE CARE • Mid 20th Century---life prolonging Rx • Prognosis gave way to treatment • Antibiotics in WWII • CPR • Gastrostomy tubes • ICU’s • Other life sustaining/prolonging treatments

  16. PALLIATIVE CARE • mid 20th century • Prognosis took lesser role • Emphasis on treatment

  17. PALLIATIVE CARE • mid 20th century • Care of the terminally ill given less importance in medical training • Talk of death and dying became socially unacceptable and seen as medical failures

  18. WHERE ARE WE TODAY?

  19. CARTOON

  20. PALLIATIVE CARE TODAY • Cost Reduction 1. 27-30% Medicare dollars spent last year of life 2. Palliative care services in hospitals save money* 3. Hospice referrals save money *Center for Advancement of Palliative Care Website:CAPC.org

  21. PALLIATIVE CARE TODAY ALLEVIATE SUFFERING

  22. PALLIATIVE CARE TODAY • HCP’s Role • Prognosis • Giving patients choices • Talk of death and dying when appropriate • Referral to palliative care and hospice when appropriate

  23. PALLIATIVE CARE TODAY • HCP’s Role • Prognosis

  24. DEATH TRAJECTORY and PROGNOSIS

  25. DEATH TRAJECTORY and PROGNOSIS

  26. DEATH TRAJECTORY and PROGNOSIS

  27. DEATH TRAJECTORY • Prognosis dwindling patient

  28. DWINDLING PATIENT

  29. DWINDLING PATIENT

  30. HCP’S ROLE • Prognostication • Difficult at best--little or no training • Foreseeing and Foretelling • Doctors are overly optimistic • Christakis, N.A. and Lamont, E.B. (2000).Extent and determinants of error in doctor’s prognoses in terminally ill patients: prospective cohort study; BMJ 320, 469-72.

  31. PALLIATIVE CARE TODAY • HCP’s Role • Giving patients choices

  32. PALLIATIVE CARE TODAY • Giving patients choices: • POLST--Cal Legislation AB 3000 effective January 1, 2009

  33. HEALTH CARE PROVIDER’S ROLE

  34. HEALTH CARE PROVIDER’S ROLE • TALK OF DEATH AND DYING • Legislation “Patient Self Determination Act” of 1991 • Requires inpatients be asked about advance care directives

  35. HEALTH CARE PROVIDER’S ROLE • TALK OF DEATH AND DYING • California law “Right to Know End-of-Life Options” Act AB 2747 • Enacted 5/2008 • Patients that have a terminal illness have to be given accurate info about treatment options and pain management

  36. HEALTH CARE PROVIDER’S ROLE • NEXT YEAR in Contra Costa County: • A Pilot program for Medi-Cal and End-of-Life administered by APS Healthcare--more next year

  37. HEALTH CARE PROVIDER’S ROLE • Talk of Death and Dying • Why is it so hard for us

  38. HEALTH CARE PROVIDER’S ROLE • Talk of Death and Dying--Myths • The hard conversation will depress patients • Patients will lose hope • Saying it will make it happen

  39. HEALTH CARE PROVIDER’S ROLE

  40. HEALTH CARE PROVIDER’S ROLE

  41. HEALTH CARE PROVIDER’S ROLE

  42. HEALTH CARE PROVIDER’S ROLE

  43. SUMMARY • Dying and death are inevitable • Palliative care or hospice--can alleviate suffering • Choices--we have them--think about them; discuss them • With life-limiting illnesses • Aggressive disease modifying treatment • Palliative care • Hospice

  44. THANK YOU • Sally Sample, MD • Email sasample@comcast.net

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