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PALLIATIVE CARE UPDATE. BY SALLY SAMPLE, MD. LIFE IS SHORT. 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 - PowerPoint PPT Presentation
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PALLIATIVE CAREUPDATE
PALLIATIVE CAREUPDATE
BY
SALLY SAMPLE, MDBY
SALLY SAMPLE, MD
LIFE IS SHORTLIFE IS SHORT
Employment AffiliationsEmployment 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
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
FINANCIAL DISCLOSUREFINANCIAL DISCLOSURE
• I have no financial gains or incentives for this talk
• I have no financial gains or incentives for this talk
GOALSGOALS
• 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
• 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
SUMMARYSUMMARY
• DEFINITIONS
• HISTORY stigma of death and dying
• PC Today and the HCP role– Some relevant references to the literature– Legislation– National and State Trends
• DEFINITIONS
• HISTORY stigma of death and dying
• PC Today and the HCP role– Some relevant references to the literature– Legislation– National and State Trends
PC DEFINITIONSPC 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
--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
PC DEFINITIONS PC DEFINITIONS
GRAPHGRAPH
HISTORYHISTORY
HISTORYHISTORY
• PALLIATIVE CARE: OLDEST FORM OF MEDICINE
• NEWEST SUBSPECIALTY
• PALLIATIVE CARE: OLDEST FORM OF MEDICINE
• NEWEST SUBSPECIALTY
PALLIATIVE CAREPALLIATIVE 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
19th century and before:
approach to illness involved family, church,
very few life prolonging treatments
family at death bed
dying was part of life
PALLIATIVE CAREPALLIATIVE CARE
• 19th century and before
• Health Care Provider Role:
Diagnosis and Prognosis– Whether the patient would succumb
• 19th century and before
• Health Care Provider Role:
Diagnosis and Prognosis– Whether the patient would succumb
PALLLIATIVE CAREPALLLIATIVE CARE
• Civil War changed nature of death and dying--no longer family at death bed
This Republic of Suffering. By Drew Gilpin Faust
• Civil War changed nature of death and dying--no longer family at death bed
This Republic of Suffering. By Drew Gilpin Faust
PALLIATIVE CAREPALLIATIVE 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
• Mid 20th Century---life prolonging Rx• Prognosis gave way to treatment
– Antibiotics in WWII– CPR– Gastrostomy tubes– ICU’s– Other life sustaining/prolonging treatments
PALLIATIVE CAREPALLIATIVE CARE
• mid 20th century
– Prognosis took lesser role
– Emphasis on treatment
• mid 20th century
– Prognosis took lesser role
– Emphasis on treatment
PALLIATIVE CAREPALLIATIVE 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
• 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
WHERE ARE WE TODAY?WHERE ARE WE TODAY?
CARTOONCARTOON
PALLIATIVE CARE TODAYPALLIATIVE 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
• 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
PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
ALLEVIATE SUFFERING ALLEVIATE SUFFERING
PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• HCP’s Role • Prognosis
• Giving patients choices
• Talk of death and dying when appropriate
• Referral to palliative care and hospice when appropriate
• HCP’s Role • Prognosis
• Giving patients choices
• Talk of death and dying when appropriate
• Referral to palliative care and hospice when appropriate
PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• HCP’s Role– Prognosis
• HCP’s Role– Prognosis
DEATH TRAJECTORY and PROGNOSISDEATH TRAJECTORY and PROGNOSIS
DEATH TRAJECTORY and PROGNOSISDEATH TRAJECTORY and PROGNOSIS
DEATH TRAJECTORY and PROGNOSISDEATH TRAJECTORY and PROGNOSIS
DEATH TRAJECTORYDEATH TRAJECTORY
• Prognosis dwindling patient• Prognosis dwindling patient
DWINDLING PATIENTDWINDLING PATIENT
DWINDLING PATIENTDWINDLING PATIENT
HCP’S ROLEHCP’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.
• 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.
PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• HCP’s Role– Giving patients choices
• HCP’s Role– Giving patients choices
PALLIATIVE CARE TODAYPALLIATIVE CARE TODAY
• Giving patients choices:
• POLST--Cal Legislation AB 3000
effective January 1, 2009
• Giving patients choices:
• POLST--Cal Legislation AB 3000
effective January 1, 2009
HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
• TALK OF DEATH AND DYING
– Legislation “Patient Self Determination Act” of 1991• Requires inpatients be asked about advance care
directives
• TALK OF DEATH AND DYING
– Legislation “Patient Self Determination Act” of 1991• Requires inpatients be asked about advance care
directives
HEALTH CARE PROVIDER’S ROLEHEALTH 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
• 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
HEALTH CARE PROVIDER’S ROLEHEALTH 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
• NEXT YEAR in Contra Costa County:
– A Pilot program for Medi-Cal and End-of-Life
administered by APS Healthcare--more next year
HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
• Talk of Death and Dying– Why is it so hard for us
• Talk of Death and Dying– Why is it so hard for us
HEALTH CARE PROVIDER’S ROLEHEALTH 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
• Talk of Death and Dying--Myths– The hard conversation will depress patients– Patients will lose hope– Saying it will make it happen
HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
HEALTH CARE PROVIDER’S ROLEHEALTH CARE PROVIDER’S ROLE
SUMMARYSUMMARY
• 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
• 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
THANK YOUTHANK YOU
• Sally Sample, MD
• Email [email protected]
• Sally Sample, MD
• Email [email protected]
