Palliation of proximal malignant biliary obstruction by endoscopic ...
Palliation e.hart
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Transcript of Palliation e.hart
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Increasing Appropriate Hospice and Palliative Services throughImproved Communication and Documentation of Patients’ Wishes
Elizabeth Balsam Hart, MDMaineGeneral Health
With support from the Practice Change Fellows Program, the Atlantic Philanthropies and the John A Hartford Foundation
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“How people die remains in the memories of those who live on.”
Dame Cicely Saunders
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3
Divisions by Health Status in the Population andTrajectories of Eventually Fatal Chronic Illnesses
Joanne Lynn, MD, MA, MS, Center to Improve Care of the Dying, RAND
Divisions in the Population
Group 1
Group 2
Group 3
“Healthy,” needsacute and
preventive care
“Chronic, not “serious”
Chronic, progressive,eventually fatalillness
Major Trajectories near Death
AA
TimeLow
High
Func
tion
Func
tion
death
Time
BB
Low
High
Func
tion
deathdeath
CC
TimeTimeLowLow
High
Func
tion
death
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Advance Care Planning
Often the concerns and wishes we have for end-of-life care emerge as the situation unfolds, or are never discussed, rather than making intentional choices, based on thoughtful discussions in advance about quality of life, values, risks and benefits, and goals of care
We often make the most difficult decisions in a time of crisis, under a shadow of grief, or at a time when communication between those involved may be challenging
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Conversations - not just forms
• Advance Care Planning is …
• “A process of coming to understand, reflect on, discuss, and plan for a time when you cannot make your own medical decisions and are unlikely to recover from your injury or illness.”
» Making Choices™ » Planning in Advance for Future Healthcare Choices» Gundersen Lutheran Medical Foundation
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Purpose of POLST (Physician Orders for Life-Sustaining Treatment)
To provide a mechanism to communicate
patient preferences for end-of-life
treatment across treatment settings
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What is POLST ?• A Set of Actionable Medical Orders
• Can be completed by any healthcare professional, but must be signed by a licensed physician*
• Complements, but does not replace, advance directives
• Voluntary use, but provides consistent recognized document
*In some states a nurse practitioner or physician assistant may sign the POLST form
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The Surprise Question
• Would you be surprised if your patient with advanced cancer died in the next year?”
• If the answer is “No”, likely appropriate for POLST
• Connections between POLST model and Cancer Plan Objectives 15.1 – 15.7