End of Lifewhat every health professional should know about palliative care

at the

Toby Campbell, MD MSCI

Objectives

• What is palliative care? • Communication strategies

– family meetings– goals of care– transitions– difficult situations

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

Physical

Spiritual

Social

Existential

Psychological

What is

Palliative Care?

Communi-Communi-cationcation

Advanced Advanced Care Care PlanningPlanning

Complica-Complica-tions of tions of TherapyTherapy

Psycho-Psycho-socialsocial

Care of the Care of the DyingDying

Symptom Symptom ControlControl

Our

Core Skills

OB/GYN

Pediatrics

Neurology

Psychiatry

Radiology

Surgery

PM&R

ER Medicine

Anesthesiology

Family Med

Internal Med

Multi-disciplinaryspecialty

Survival Curve: Disease

Normal Population

Disease

%survival

Time

Cure

Normal Population

%survival

Time

Cure

Life Prolongation

Normal Population

%survival

Time

Prolongation of survival

Palliative Care

Normal Population

Palliative Palliative CareCare

%survival

Time

Intentions of Treatment

Palliative

Curative

Traditional Model of Cancer Care

HospiceStandard Cancer Care

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

Bereavement

Modern Model

Traditional Care

Palliative Care

Hospice

Death6-Month PrognosisDiagnosis

Focus of

Care

Time

Symptom Burden

Campbell TC et al Semin Intervent Radiol 2007

Does

Palliative Care Matter?

Transfers to PCU

Oncology Unit

Oncology or Palliative Care?Oncology or Palliative Care?

on the

Lung26%

GI26%Breast

17%

Other16%

GU15%

84%

“Big 4”

4.7 months4.7 months

27% 1 year survival27% 1 year survival

Difficult ConversationsOh No!

A communication toolkit•SPIKES•NURSE•I Wish•Hope for the Best, Plan for the worst•Outcome Oriented•Make a Recommendation

Setting the Scene

Understand their Perception

Get an Invitation

Share Your Knowledge

Silence

Empathic Statements• NURSE

– Naming– Understanding– Respecting/Praising– Supporting– Exploring

• I Wish Statements

Summarize

Strategize

Transitions in CareGoals TransitionsHeroesDenial

Tough Times

Where are we going?

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

Transitions in care

Fix Knowledge barriers

Orient to Outcomes

Respond toEmotion

The 11th Hour Hero

I want everything done

Thank You

Toby Campbell608-206-9109 (m)