End of Life Care Many studies have described difficulties in the final phase of life, including inadequate symptom management, care mismatched with patient preferences, and inappropriate resource use. (Lorenz, et al (2007) JAGS 55:S318-S326 10 Steps for a Family Conference or Giving Bad News Advanced Care Directives 4-Year Mortality Index for Older Adults Preparation Establish Proper Setting Introductions/Goals/Relationship Family Understanding of Condition Medical Review/Summary Silence/Reactions Present Broad Care Options/Set Goals Translate Goals into Care Plan Document and Discuss Managing Conflict Legally binding documents prepared by a person capable of making informed decisions that designate a surrogate decision maker to protect their rights and wishes to request or refuse treatment in the event of losing decision making capacity. Desire for a Natural Death States the patients’ wishes South Carolina’s “Living Will” Must be signed and notarized Springs into effect if patient is terminally ill OR in a persistent vegetative state Patients’ wishes regarding tube feeding can not be overridden by a physician OR surrogate. Health Care Power of Attorney Identifies a surrogate decision maker Addresses organ donation, life sustaining treatment, and tube feeding Patient can provide any additional instructions on this form. Documents should be scanned into Practice Partner and OACIS South Carolina will honor an out-of-state Advanced Directive Aging Q3 is funded by the D.W. Reynolds Foundation Age 60-64 1 65-69 2 70-74 3 75-79 4 80-84 5 ≥85 7 Sex Male Female BMI <25 Has a doctor ever told you that you have: Diabetes Yes Cancer or malignant tumor, exc. minor skin cancers Chronic Lung Disease that limits usual activities or makes you need 02 at home CHF Have you smoked cigarettes in past week? Because of health or memory problems, difficulty with: Managing your money such as paying your bills and keeping track of expenses? Walking several blocks? Pulling or pushing large objects like a living room chair? Risk of 4 Year Mortality: 0-5 3% risk; 6-9 15% risk; 10-13 40% risk and 14+ 67% risk Total Points: Reference: Lee SJ, Lindquist K, Segal MR, and Covinsky AE. (2006) Development and Evaluation of a Prognostic Index of 4-Year Mortality in Older Adults. JAMA 295 (&):801-808 http://www.soapnote.org/elder-care/4-year-prognostic-index/ Risk % Listening and Empathy Tell me your understanding of the current medical condition? Can you tell me something about your father? How have things been going the past 3 months? What is important in the time you have left? This must be very hard. Adapted from Weissman, D. at Medical College of Wisconsin Research Foundation, Inc. http://www.eperc.mcw.edu/fastfact/ff 011.htm