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End of Lifewhat every health professional should know about palliative care
at the
Toby Campbell, MD MSCI
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Objectives
• What is palliative care? • Communication strategies
– family meetings– goals of care– transitions– difficult situations
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http://www.theonion.com/content/news/world_death_rate_holding_steady_at
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Physical
Spiritual
Social
Existential
Psychological
What is
Palliative Care?
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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
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OB/GYN
Pediatrics
Neurology
Psychiatry
Radiology
Surgery
PM&R
ER Medicine
Anesthesiology
Family Med
Internal Med
Multi-disciplinaryspecialty
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Survival Curve: Disease
Normal Population
Disease
%survival
Time
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Cure
Normal Population
%survival
Time
Cure
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Life Prolongation
Normal Population
%survival
Time
Prolongation of survival
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Palliative Care
Normal Population
Palliative Palliative CareCare
%survival
Time
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Intentions of Treatment
Palliative
Curative
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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
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Modern Model
Traditional Care
Palliative Care
Hospice
Death6-Month PrognosisDiagnosis
Focus of
Care
Time
Symptom Burden
Campbell TC et al Semin Intervent Radiol 2007
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Does
Palliative Care Matter?
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Transfers to PCU
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Oncology Unit
Oncology or Palliative Care?Oncology or Palliative Care?
on the
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Lung26%
GI26%Breast
17%
Other16%
GU15%
84%
“Big 4”
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4.7 months4.7 months
27% 1 year survival27% 1 year survival
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Difficult ConversationsOh No!
A communication toolkit•SPIKES•NURSE•I Wish•Hope for the Best, Plan for the worst•Outcome Oriented•Make a Recommendation
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Setting the Scene
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Understand their Perception
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Get an Invitation
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Share Your Knowledge
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Silence
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Empathic Statements• NURSE
– Naming– Understanding– Respecting/Praising– Supporting– Exploring
• I Wish Statements
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Summarize
Strategize
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Transitions in CareGoals TransitionsHeroesDenial
Tough Times
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Where are we going?
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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
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Transitions in care
Fix Knowledge barriers
Orient to Outcomes
Respond toEmotion
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The 11th Hour Hero
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I want everything done
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Thank You
Toby Campbell608-206-9109 (m)