PALLIATIVE CARE OF HEART FAILUE, COPD AND IN THE ACUTE TRUST (in 5 minutes!!) Dr Sharon Chadwick Macmillan Consultant in Palliative Medicine Hospice of St Francis

Heart Failure and COPD Main problems –‘There is nothing else we can do’ –Lack of recognition of what palliative care can achieve. –Fear of the Hospice in patients –Helplessness/hopelessness in healthcare professionals –Prognostic paralysis

Prognostic paralysis Fears of HCPs around introducing advanced care planning too early mean –People dying unprepared –Indadequate symptom control –No choice in where they die

Key points in Heart Failure Symptom control of breathlessness Seek out other symptoms Rationalisation of medication Advanced care planning

Key points in COPD Management of breathlessness and anxiety Seek out other symptoms Carer support Advanced care planning

What are we doing? Education sessions Monthly meeting with specialist respiratory nurses/ specialist heart failure nurses and community matrons Reaching out to patients –Breathe Easy Groups –Patient Information leaflets

In Hospital Often too little too late Only for patients on the LCP No recognition of possibility of palliative care working alongside active management in patients likely to die No recognition that patients might die!

Plan of Action in the Hospital Education, education, education! Helping with difficult ethical dilemmas –Feeding issues –Hydration issues In through the back door –Ward nurses –Ear to the ground Showing what can be achieved