Introduction to Palliative Care Erin Fitzgerald, MD Jessica A Alle Corliss, LCSW Monica M. Sandoval, MD Department of Palliative Medicine

Objectives Define Palliative Care Outline Palliative Care at UNMH Define Hospice Discuss when to consult Palliative Care

Myths about Palliative Care MYTH 1: It hastens death “they will order the Morphine drip” MYTH 2: It means doctors have given up, “there is nothing else to do” MYTH 3: Its for old or dying people “ means I am dying” MYTH 4: Palliative care means no more treatment “same as hospice” Palliative care is still widely misunderstood by many Barrier to timely PC referrals

The goal is not to hasten death nor o prolong dying process. What is Palliative Care? Provided by an interdisciplinary team 1 team together makes 1 care plan Can be provided in conjunction with life prolonging treatment No need to choose between tx plans Appropriate at any age and any stage of illness. The goal is not to hasten death nor o prolong dying process. “Specialized medical care for people with serious illness. This type of care is focused on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family.” QUALITY OF LIFE RELIEF OF SUFFERING

PALLIATIVE CARE DOMAINS Care of the dying patient Framework Disease Management Care of the dying patient Psychological Patient + Family Functional status Social, Cultural & Ethical Physical Aspects of Care – pain, dyspnea, nausea/vomiting, fatigue, constipation, performance status, medical diagnoses, medications (add/wean/titrate) Psychological Aspects of Care – anxiety, depression, delirium, cognitive impairment; stress, anticipatory grief, coping strategies; pharm/non-pharm treatment; patient/family grief/bereavement; Social Aspects of Care – family/friend communication/interaction/support; caregiver crisis Spiritual Aspects of Care – spiritual/religious/existential; hopes/fears; forgiveness; Cultural Aspects of Care – language, ritual, dietary, other. Care of the Imminently Dying – presence; recognition and communication to patient/family education/normalization; prognosis (eg hours to days; very few days; etc) Ethical & Legal Aspects of Care – decision maker; advance directives Spiritual Focuses on the “illness”, not just the “disease” What is this patient’s and family’s experience of the disease, and how can we help them all live as fully as they can in whatever time they have?

Each patient is unique and their path is their own How does palliative care help you and your patients? * Unacceptable pain or symptom distress Team/patient/family needs help with complex decision-making Goals of care & Advance Care Planning Prognostication Team support Emotional, spiritual and psychological support May improve survival * Fewer hospital days Less likely to die in an ICU How can we help? “No agenda” Each patient is unique and their path is their own Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer led to significant improvements in both quality of life and mood and longer survival (~2.5 months). NEJM Temel et al. 2010

Shared Decision-Making Model

Bringing Palliative Care Upstream Primary Palliative Care Skills Basic pain and symptom management Code status Communication Goals of care Palliative care can be delivered by specialist working with primary providers Palliative care be delivered by clinicians who are not specialist, internist, doctors, nurses, oncologist….etc and other clinician that are caring for seriously ill patients,

OUR SPECIALIST Great Support Great Medicine Accurate Diagnosis Suitable for all categories business and personal presentation Suitable for all categories business and personal presentation. Suitable for all categories business and personal presentation. *Patient seeing the world outside like a fantasy that he longs to be part of *Contrasting with sense of immobility *Points to the struggles of many patients with neurological diseases

What is Hospice? Interdisciplinary team provides care Patients with a limited life expectancy and who choose to focus on quality of life rather than exclusively on length of life Intensive pain and symptom management, and patient/family support Two MDs certify prognosis < 6 months if “disease runs its usual course” It is a philosophy, not a place Hospice is a health care benefit and a philosophy of care. Medicare (Part A) benefit since 1983. FOCUS ON COMFORT AND RELIEF FROM SUFFERING NOT ON LIFE PROLONGATION

Palliative Care or Hospice care: What’s the difference? Hospice: 2 MDs certify that prognosis is <6 months if illness runs its natural course; treatments are comfort focused, not curative Palliative Care: No prognostic requirement; inpatient consultation service to help alleviate suffering in patients with serious or life threatening illness All hospice care is palliative care But not all palliative care is hospice care

Inpatient Consultation Outpatient Consultation UNMH Palliative Care Team Inpatient Consultation Our Team: Physicians Advance Practice Providers Social Workers Chaplain Arts-in-Medicine Administrative Assistant Outpatient Consultation Bereavement Services Physicians (All Board Certified in Palliative Medicine) plus: Marr and FitzGerald: Internal Medicine Neale: Geriatrics Camarata: Family Medicine Finlay: Medical Oncology Fahy: Surgical Oncology Doezema: Emergency Medicine Sandoval: Geriatrics ANPs: Harlow, Marsh, Knight, Acosta SW: Lee and Alle-Corliss Pastoral Care: Ferguson Arts-in-Medicine: Repar and team Call 272-4868 - for information or referral

Who is appropriate for a palliative care consultation? 1 Unacceptable pain or symptom distress with serious/life threatening illness Who is appropriate for a palliative care consultation? 2 Team/Patient/Family Needs help with complex decision making & determination of goals of care 3 Advance Care Planning/ Tube Feedings discussions Write Here Something The most basic business structure is a sole proprietorship. The owner of the business is the sole individual who takes ownership of assets and debt obligations. Alternatively, multiple individuals with shared duties can operate a business, and this business structure is a partnership. A business may operate as a 4 Prognostication 5 Patient, Family or Team support