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We Need Palliative Care Everywhere
SMACC DUB 2016 Ashley Shreves, MD
Dept of Emergency Medicine Ochsner Medical Center
New Orleans, LA
Specific challenges• Identify dying trajectory
• Capacity assessment
• Advance directives
• Difficult communication
• Withholding/withdrawing LST
• EOL symptom management
• Spiritual competency
• Ethics
• Systems of care
Conversations bad, brief or nonexistant
Dying patients “neglected;” staff uncomfortable
Dying in hospital: less respect, quality of care worse
Relevant to you?
Canada: 1/3 cancer patients visit ED last 2 wks of life
Australia: 65% patients w serious illness die in hospital/ED
Consult Palliative Care?
• Sure, but…
• 67% US hospitals (50+ beds) have pal care
• Workforce shortage: have 3K, need 18K (just in hospital)
• There will never be enough
Lupe D et al. J Pain Symptom Manage 2010 Dumanovsky T et al. J Palliate Med 2016
Kamal AH et al. Ann Intern Med 2015