Palliative Care Program Wentworth-Douglass Hospital

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1 Palliative Care Program Wentworth-Douglass Hospital Patrick S. Alix, MD Director Michele Loos, RN, MS, CHPN Nurse Coordinator

2 DEFINITION: PALLIATIVE CARE Interdisciplinary care that aims to relieve suffering and improve quality of life for patients with advanced illness, and their families. It is offered simultaneously with all other appropriate medical treatment. Center to Advance Palliative Care

3 DEFINITION: PALLIATIVE CARE Refers to patient- and family-centered care that optimizes QoL by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice. Centers for Medicare and Medicaid Services

4 The Cure - Care Model: The Old System Life Prolonging Care Palliative/ Hospice Care D E A T H

5 The Abiding Desire Not to Be Dead I don t want to achieve immortality through my work. I d rather achieve it by not dying. Woody Allen Studies of patients with serious illness report increasing desire for aggressive therapies as health status declines. Fried et al. Arch Intern Med 2006;166:

6

7 A New Vision of Palliative Care Therapies to modify disease Life Closure Hospice Benefit Palliative Care Presentation Therapies to relieve suffering and / or improve quality of life 6 mos to Death Bereavement Care

8 Continuum of Palliative Care Cure Palliative Active Palliative Symptomatic Palliative Supportive Palliative Care Learning Center Hospice of the Bluegrass

9 Stages of the Continuum of Palliative Care CURATIVE PALLIATIVE ACTIVE Goal is cure Goal is prolong life/survival Eliminate tumor/disease Arrest/Control tumor/disease Mind set is to win Mind set is to fight CPR is appropriate intervention CPR probably appropriate Is not hospice appropriate Is not not hospice appropriate Palliative Care Learning Center Hospice of the Bluegrass

10 Stages of the Continuum of Palliative Care PALLIATIVE SYMPTOMATIC Goal is comfort Some response in control of tumor/disease Mind set is hope/living with it CPR- varies in appropriateness Hospice appropriate maybe PALLIATIVE SUPPORTIVE Goal is comfort No response to treatment/disease control Mind set is acceptance CPR is not appropriate Is hospice appropriate Palliative Care Learning Center Hospice of the Bluegrass

11 All hospice care is palliative, but not all palliative care is hospice. Palliative Care Hospice

12 Palliative Care Approach of care Regards dying as a natural process Neither hastens nor postpones death Relieves pain and other symptoms Integrates psychosocial and spiritual aspects Promotes human dignity and autonomy Supports patients and families Palliative care No care!

13 Palliative Care: Continued Hope Hope: An expectation greater than zero of reaching a goal Not necessarily hope for an ultimate cure or longer survival time Hope for quality time, relief of pain and growth and development at life s end

14 Palliative Care Goal-oriented: Care is individualized to meet the patient s goals and needs Ask the patient: What do you hope will come out of this? Comfortable peaceful living until death Specific goal: e.g special event or date (wedding, graduation)

15 Palliative Care: Three Goals All diagnostic or therapeutic plans be made in terms of the sick person, not the disease. To maximize patient s function, not necessarily the length of life. To minimize the suffering of the patient and family. Eric Cassell, MD. The Nature of Suffering

16 Palliative Care Program Where is the PC Program? When did it start?

17 Seacoast Palliative Care February 26, 2007 Monday-Friday 7:30 AM-3:30 PM Consultative Service Inpatient Outpatient LTC Facility Assisted Living Work Flow MD Referral OCM Pathway Screening FTE: MD Program Director Clinical Nurse Coordinator Program Manager Part time: Nurse Practitioner Shared: Social Worker Chaplain

18 Seacoast Palliative Care Palliative Care Program In Patient Consultative Services Out Patient Seacoast Palliative Care Clinic Emergency Department Palliative Care Unit Seacoast Cancer Center Home Long Term Care Facility

19 Palliative Care Program WDH PC Program Inpatient Palliative Care Unit Consultative Service Emergency Department Outpatient Services Seacoast Palliative Care Clinic Wentworth Homecare and Hospice Home/ Long Term Care Facility

20 Mission of the Palliative Care Program: 1. To relieve suffering and improve the quality of life for patients with chronic or life threatening illness or illnesses and their families with the highest quality of care. 2. Identify, honor and respect the preferences of the patient and family through careful attention to their values, goals and priorities, as well as their cultural and spiritual perspectives.

21 Mission of the Palliative Care Program: 3. Assist patients with honesty and compassion in establishing goals of care by facilitating their understanding of their diagnosis and prognosis, clarifying priorities, promoting informed choices and providing an opportunity for negotiating a care plan with providers. 4. Strive to meet patients preferences about care settings, living situations and services, recognizing the uniqueness of these preferences and the barriers to accomplishing them.

22 Mission of the Palliative Care Program: 5. Encourage advance care planning, including advance directives, through ongoing dialogue among providers, patient and family. 6. Recognize the potential for conflicts among patient, family, providers and payors, and develop processes to work toward resolution.

23 Palliative Care aims to improve care 3 elements: 1. Relieve physical and emotional suffering 2. Improve patient-physician communication and decision-making 3. Coordinate continuity of care across settings

24 Benefits of Palliative Care: The Evidence Base Reduction in symptom burden Improved patient and family satisfaction Reduced costs

25 A New Vision of Palliative Care Therapies to modify disease Life Closure Hospice Benefit Palliative Care Presentation Therapies to relieve suffering and / or improve quality of life 6 mos to Death Bereavement Care

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