Presentation on theme: "End of Life Curriculum Project-Lunchtime symposia for M1 & M2 Daniel McFarland NYCOM 2004."— Presentation transcript:
End of Life Curriculum Project-Lunchtime symposia for M1 & M2 Daniel McFarland NYCOM 2004
Introduction and overview of palliative care and hospice 1) History of the hospice movement and statistics of death and dying in America. 2) Definitions of hospice according to Medicare benefit. Define palliative and hospice care. 3) Interdisciplinary approach to patient care in hospice. 4) Never take away hope. Shift focus from curative to making person comfortable and autonomous. Change goals of care. 5) Difficulties of prognostication. Use ADL’s and Palliative Performance Scale, unintentional weight loss (cachexia) etc..as measurements. Cancer, E/S Cardiac, E/S Pulmonary, E/S dementia, Adult Failure to Thrive-Debility 6) Physician resistance to refer to hospice, lack of understanding on part of doctor and patient: Address fear of morphine associated with respiratory suppression and addiction, 30% of patients refuse pain meds at the end of life. 7) Effective communication and communicating bad news. SPIKES. Talking about DNR, advanced directives and POA.
End of Life Physical Symptoms 1) Prevalence of weakness (#1 symptom)...multifactorial (effect of underlying disease, cachexia, anemia, depression etc..) 2) Falls can mean a shortened life span. What are the risk factors? Do physical assessment, modify environment and reduce risk. Tai chi and black holes! 3) Pressure ulcers stage 1-4. Risk factors are immobility, hypoalbuminemia, incontinence, pressure of fracture. Prevent by repositioning and dryness. 4) Edema. Causes and treatments. 5) Hospice emergencies when aggressive treatment is necessary. Spinal cord compression, DVT, subdural hematoma. 6) Delirium vs. Dementia. Depression and anxiety at the end of life. 7) Dyspnea: subjective sense that you need air. Assess cause-may be treatable. CXR findings? Provide oxygen and opioids. Anxiolytics (Ativan, Xanax) does not suppress respiration. Use of nonpharmicalogical agents 8) Gastrointestinal symptoms and management. Anorexia, xerostomia, nausea, constipation, diarrhea.
Managing acute and chronic pain 1) Etiology of pain. Visceral, somatic and neuropathic pain. Pain history. 2) WHO Step Ladder Drugs vs. Dr. Marschke’s revised addition. 3) Pain factors: psychological, socioeconomic, spiritual, physical. 4) Treating somatic, visceral and neuropathic pain. The use of pain adjuvants and CAM adjuvants. 5) How to dose using an opioid. PRN. Long acting vs. short acting opioids. 6) Opioid side effects: constipation and physical vs. psychological dependence. Pseudo-addiction.
Issues of Spirituality, ethics, law and CAM 1) Ethics vs. law 2) Skilled and caring communication, physician leadership, ethics committees. 3) What is an Advanced Directive? What happens when an AD does not exist? 4) Informed consent. When does a patient give over informed consent? Difference between capacity and competency. 5) Perspectives on withholding and withdrawing. CPR, feeding tubes, futility 6) Physician Assisted Suicide, Terminal Sedation, Voluntary Stopping Eating and Drinking.
Additional Ideas 1) Begin on-line forum, post journal articles and websites. 2) Present the movie “to live until I die”