Jennifer Ritzau, MD Director of Palliative Care June 10, 2016 Palliative Care Adding Value in Health Care CTC-RI Breakfast of Champions Jennifer Ritzau, MD Director of Palliative Care June 10, 2016

What is palliative care? Medical care especially designed for people living with a serious, life-threatening illness Not limited to “comfort only” Not limited to terminally ill patients Not a euphemism for hospice care Work with the existing health care team to provide an extra layer of support to patient and family

The Serious Illness Continuum

What do we do? Symptom management Goals for care discussions Advance Directives Delivering serious news Addressing emotional and spiritual needs Assist with prognostication Assisting with transitions in care

We have excellent quality data on our side Improved quality of life Improved patient and team satisfaction Diminished caregiver distress Improve symptom burden Increase in advance care planning Improvement in survival Irwin et al Chron Respir Dis 2012; 10(1) 35-47 Glare P JNCCN 2013:11 (supp 1):s3-9 Casarett et al J AM Ger Soc 2008:56 (4)593-599 Elsayem et al J Clin Oncol 2004;22 (10) 2008-14 Higginson et al J Pain Symptom Manage 2003; 25(2) 150-168 Ringdal et al Pain Symptom Manage 2002; 24 (1) 53-63 Temel et al N Engl J Med. 2010 Dec 2;363(23):2263

Cost / Quality Care Gap Care Gap Tier 3A 5 % Population 50% Cost Stage 1 Stage 2 Stage 3 Care Gap Terminal Mourning Stage 4 CHRONIC DISEASE 220 Years SERIOUSLY ILL 1824 Months HOSPICE 6 Mos. or Less GRIEF SUPPORT— MAYBE Tier 3A 5 % Population 50% Cost 6

To be of Value in health care today  

Barriers Abound… Health Care System Patients Families Providers

Primary Palliative Care Patients would rather YOU be the “someone who can” Bring value to the patient encounter What is important What will this next test/admission accomplish Overwhelming evidence that better communication skills combats physicians burnout, reduces angry patients, litigation

Primary Palliative Care Elicit what is most important to you patient Be Honest “I am worried about how sick you are” Advance care planning Basic symptom management for seriously ill patients ( pain, dyspnea, nausea, anxiety)

Suboptimal communication creates a vicious spiral that makes us feel more like hamsters on a wheel than healers… Anthony Back et.al

Patient’s Preference Elders asked to rank living longer, good pain and symptom control or maintaining independence…

Survey says… 76% Maintain Independence Good pain and symptom management Living longer This is NOT withholding or rationing care- this is aligning care with preferences…added value

As a result of a failure to prognosticate, let alone prognosticate accurately, patients may die deaths they deplore in locations they despise Nicholas Christakis (Emergency Physician Feb 2014, p24-25)

What Would You Want? To take a last vacation? Spend time with your kids? Get your affairs in order? Go back to your NH where everyone knows you? Something different than what out patients are going through? When we wait until the last minute, we rob our patients of this time and irreplaceable memories.

Support Dignity Privacy Help for your family Best symptom control possible

Do our patients and families deserve anything less?

Call if We Can Help! Hope Hospice and Palliative Care 782-0725 Inpatient consults at RIH, TMH, Newport and SCH Consult service some LTC Facilities Skilled Home Care – Visiting Nurse Hope Health 800-696-7991 Hope Palliative Care Center (clinic)383-2896