4 DIFFERENCES 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
5 NON-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
9 WHO DEFINITION of PALLIATIVE CARE An approach that improves quality of life.Life-threatening illnessPrevention and relief of sufferingEarly identificationImpeccable assessmentTreatment – physical, psychological, spiritual.
11 WHO 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?
12 SHOULD THE PALLIATIVE CARE TEAM BECOME INVOLVED, AND WHEN?Hospital-based Palliative SpecialistsHospice out-patient clinicsDay Hospice attendanceHospice admission
13 BARRIERS to ACCESSING SPECIALIST PALLIATIVE CARE SERVICES
14 From Cardiology Palliative care only for dying patients Need to continue active interventionConcerns medications will be stoppedLack of understanding what SPC can offer
15 From Specialist Palliative care Floodgates will open / patient loadStretch charitable funding? Skills to manage these patientsChronically ill - ? Exacerbation? Block beds
16 From Patients I don’t have cancer I’m not dying Distressing Lack of understanding – their diseasepalliative care
19 AN EQUITABLE SERVICE All life-limiting illnesses under SPC umbrella Early introduction to the servicePatient and carer educationEnd-of-Life discussionsPPC documentsDay hospice
20 END-STAGE HEART FAILURE Optimal treatment but still symptomaticPrinciples of Symptom controlAssessment and investigationIntervention to reversible factorsPalliation of irreversible factorsRationalisation of medicationRenal dysfunction / Hypotension
21 MEDICATIONS Statins – stop Aspirin / Clopidogrel – stop ACE Inhibitors – reduce if renal dysfunctionLoop diureticsSpironolactoneB BlockersDigoxin – stop, unless in AF