1. Palliative Care Kenneth Morgan Sauer, MD Baptist Health Systems
June 3, 2015

2. Palliative Care
The United States is expected to experience rapid aging of the population over the next few decades. By the year 2050, the number of Americans over age 65 is expected to grow to million, up from 40.2 million in more than double.
As adults age, their medical conditions become less responsive to curative treatment, and they also experience significant physical and cognitive decline. This is often why they require long-term care.

3. Objectives
Understand the principles of palliative care and how it differs from traditional models
Understand the importance of establishing and fulfilling goals of care as a critical element of palliative care
Describe the common physical and psychological symptoms at end-of-life and ways to address them using a palliative approach
Describe ways to recognize the final hours and how best to support the patients and families/loved ones

4. What is Palliative Care?
The World Health Organization (WHO) defines palliative care as an “approach that improves the quality of life of patients and their families facing the problems associated with life- threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems-- physical, psychosocial, and spiritual.”

5. Understanding Palliative Care
Palliative care differs from traditional care in that it typically does not rely heavily on invasive tests or procedures or other diagnostic methods that are aimed at finding a cause or cure for a certain symptom or medical condition!
Rather than curing disease, palliative care focuses on alleviating discomfort.
It’s all about patient COMFORT!

6. Palliative Care vs. Hospice Care
Palliative care is similar to hospice
Both share the same philosophy
Palliative care may be utilized at any time during treatment

7. Palliative Care vs. Hospice Care
Hospice usually delivered by a hospice care team vs. traditional team
Hospice is a Medicare/Medicaid/private insurance benefit
Hospice has regulations regarding care and eligibility.

8. Palliative Care vs. Hospice Care
Palliative care does not have regulatory restrictions
Hospice is a branch of palliative care.
All hospice is palliative care, but palliative care is much more than just hospice.

9. Palliative Care Relief from pain and distress
Regards dying as a normal part of the life cycle
Does not hasten or postpone death
Uses biopsychosocial model of care
Team approach for pt/family needs
Support for caregiver stress and bereavement

10. Who Provides Palliative Care?
Palliative care is not just medical care or nursing care
All team members play a vital role in palliative care
All team members must be supportive of this approach to care.

11. Palliative Care Team
Nurse- primary provider, caries out most aspects of care plan. Monitors patient’s physical condition, symptoms, and response to interventions
Nurse Assistant- helps identify needs and response to intervention. Delivers non-medical palliative interventions

12. Palliative Care Team
Social Worker- helps patients/families plan EOL issues: finances, funeral, and legal arrangements. Provide support, identify & address emotional needs.
Chaplain- spiritual/emotional support to patients, families, AND STAFF!!!

13. Palliative Care Team
PT/OT- therapies and supportive devices for max comfort. Caregiver education to assist with care.
MD/DO/APN/PA- orders interventions, prognostication, medical diagnoses, directs the team approach

14. Palliative Care Team
Recreation therapist- helps design pleasure activities, assist with getting the most fun out of life
Dietician- assist with meal planning, shopping instructions
Pharmacist- evaluate medications and interactions (including diet and OTCs).

15. Developing The Palliative Care Plan
Agreed by all team members and propelled by nursing to address the following:
Goals of Care
Physical Symptoms
Psychological Symptoms
Family Needs and Concerns
Liberalized Restrictions

16. Goals of Care Clarify palliative care does not mean withdrawing care
Frame a plan to meet goals of care
Revisit plan frequently with team & caregivers/family
Complete advanced directives
Know various types
Understand the family may be overwhelmed.

17. Symptoms of End of Life Pain: Common. May be complex
Respiratory: dyspnea, cough, wheeze
GI: Nausea, constipation, aspiration
Psychological: Depression, anxiety, hallucinations, delirium, decreased LOC
Spiritual: Crisis of faith

18. Interventions Long acting + PRNs vs. PRNs (esp pain)
Oxygen, inhaler vs. nebulizer, diuretics, steroids
Anti-nausea meds, bowel stimulants vs. osmotic agents
Anti-depressants, anxiolytics
Non-pharmacologic therapies

19. Addressing Spiritual Needs
Offer religious music, writings, or icons
Arrange for spiritual leader visit
Facilitate rituals
Assist with funeral arrangements
DO NOT WAIT UNTIL THE LAST MINUTE!!!!!!

20. Cultural Considerations
Most people have more than one culture
Manifested through values, beliefs, customs, and behaviors
Affects decision making, views on death, & many other aspects of care
Race, ethnicity, religion, and lifestyle contribute to culture

21. Preserving Dignity Cleanliness and oder control Bathing and grooming
Mouth and nail care
Clothing and bedding
Maximize independence

22. The Final Hours Pain and noisy breathing
Attending to symptoms and hygeine
Limited food/fluid intake
Maintaining personhood
Talk to resident appropriately
Educate family

23. Thank You! Any Questions?