End of Life what every health professional should know about palliative care at the Toby Campbell,...
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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
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
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
Difficult ConversationsOh No!
A communication toolkit•SPIKES•NURSE•I Wish•Hope for the Best, Plan for the worst•Outcome Oriented•Make a Recommendation
Empathic Statements• NURSE
– Naming– Understanding– Respecting/Praising– Supporting– Exploring
• I Wish Statements
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