Presentation on theme: "LIFE-LIMITING ILLNESS"— Presentation transcript:
1END-OF-LIFE CARE HEART FAILURE and COPD Dr Sally Reeder Specialty Doctor in Palliative Medicine
2LIFE-LIMITING ILLNESS SymptomsPatient and carer needsPsychological supportSpiritual needsSocial isolationCarer supportQuality of Life
3PARALLEL SYMPTOMS Lethargy Decreased mobility Pain Dyspnoea Anorexia NauseaDepressionAnxietyDecreased QOL
4DIFFERENCES Predicting mortality Terminal phase Understanding of diagnosis and prognosisDiscussions about prognosisEnd-of-Life discussionsContact with health and social servicesFinancial supportAvailability of specialist services in community
5NON-CANCER PATIENTS Unpredictable illness trajectory Acute events – hospital admissionsPatient attitude to diagnosisTiming of death uncertain?opportunities for End-of-Life discussionsPatient choicePalliative specialist involvement limited
9WHO DEFINITION of PALLIATIVE CARE An approach that improves quality of life.Life-threatening illnessPrevention and relief of sufferingEarly identificationImpeccable assessmentTreatment – physical, psychological, spiritual.
11WHO SHOULD DELIVER THIS PALLIATIVE CARE? General Practitioners? Cardiologists?Specialist clinic staff?WHEN AND WHERE SHOULD IT BE DELIVERED?At diagnosis?Clinic appointments?Hospital admissions?GP appointments?
12SHOULD THE PALLIATIVE CARE TEAM BECOME INVOLVED, AND WHEN?Hospital-based Palliative SpecialistsHospice out-patient clinicsDay Hospice attendanceHospice admission
13BARRIERS to ACCESSING SPECIALIST PALLIATIVE CARE SERVICES
14From Cardiology Palliative care only for dying patients Need to continue active interventionConcerns medications will be stoppedLack of understanding what SPC can offer
15From Specialist Palliative care Floodgates will open / patient loadStretch charitable funding? Skills to manage these patientsChronically ill - ? Exacerbation? Block beds
16From Patients I don’t have cancer I’m not dying Distressing Lack of understanding – their diseasepalliative care
19AN EQUITABLE SERVICE All life-limiting illnesses under SPC umbrella Early introduction to the servicePatient and carer educationEnd-of-Life discussionsPPC documentsDay hospice
20END-STAGE HEART FAILURE Optimal treatment but still symptomaticPrinciples of Symptom controlAssessment and investigationIntervention to reversible factorsPalliation of irreversible factorsRationalisation of medicationRenal dysfunction / Hypotension
21MEDICATIONS Statins – stop Aspirin / Clopidogrel – stop ACE Inhibitors – reduce if renal dysfunctionLoop diureticsSpironolactoneB BlockersDigoxin – stop, unless in AF