1. 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: % risk; % risk; % risk and % 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 (&):
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 htm