Palliative Care Kenneth Morgan Sauer, MD Baptist Health Systems June 3, 2015

Palliative Care The United States is expected to experience rapid aging of the population over the next few decades. By the year 2050, the number of Americans over age 65 is expected to grow to 88.5 million, up from 40.2 million in 2010--more than double. As adults age, their medical conditions become less responsive to curative treatment, and they also experience significant physical and cognitive decline. This is often why they require long-term care.

Objectives Understand the principles of palliative care and how it differs from traditional models Understand the importance of establishing and fulfilling goals of care as a critical element of palliative care Describe the common physical and psychological symptoms at end-of-life and ways to address them using a palliative approach Describe ways to recognize the final hours and how best to support the patients and families/loved ones

What is Palliative Care? The World Health Organization (WHO) defines palliative care as an “approach that improves the quality of life of patients and their families facing the problems associated with life- threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems-- physical, psychosocial, and spiritual.”

Understanding Palliative Care Palliative care differs from traditional care in that it typically does not rely heavily on invasive tests or procedures or other diagnostic methods that are aimed at finding a cause or cure for a certain symptom or medical condition! Rather than curing disease, palliative care focuses on alleviating discomfort. It’s all about patient COMFORT!

Palliative Care vs. Hospice Care Palliative care is similar to hospice Both share the same philosophy Palliative care may be utilized at any time during treatment

Palliative Care vs. Hospice Care Hospice usually delivered by a hospice care team vs. traditional team Hospice is a Medicare/Medicaid/private insurance benefit Hospice has regulations regarding care and eligibility.

Palliative Care vs. Hospice Care Palliative care does not have regulatory restrictions Hospice is a branch of palliative care. All hospice is palliative care, but palliative care is much more than just hospice.

Palliative Care Relief from pain and distress Regards dying as a normal part of the life cycle Does not hasten or postpone death Uses biopsychosocial model of care Team approach for pt/family needs Support for caregiver stress and bereavement

Who Provides Palliative Care? Palliative care is not just medical care or nursing care All team members play a vital role in palliative care All team members must be supportive of this approach to care.

Palliative Care Team Nurse- primary provider, caries out most aspects of care plan. Monitors patient’s physical condition, symptoms, and response to interventions Nurse Assistant- helps identify needs and response to intervention. Delivers non-medical palliative interventions

Palliative Care Team Social Worker- helps patients/families plan EOL issues: finances, funeral, and legal arrangements. Provide support, identify & address emotional needs. Chaplain- spiritual/emotional support to patients, families, AND STAFF!!!

Palliative Care Team PT/OT- therapies and supportive devices for max comfort. Caregiver education to assist with care. MD/DO/APN/PA- orders interventions, prognostication, medical diagnoses, directs the team approach

Palliative Care Team Recreation therapist- helps design pleasure activities, assist with getting the most fun out of life Dietician- assist with meal planning, shopping instructions Pharmacist- evaluate medications and interactions (including diet and OTCs).

Developing The Palliative Care Plan Agreed by all team members and propelled by nursing to address the following: Goals of Care Physical Symptoms Psychological Symptoms Family Needs and Concerns Liberalized Restrictions

Goals of Care Clarify palliative care does not mean withdrawing care Frame a plan to meet goals of care Revisit plan frequently with team & caregivers/family Complete advanced directives Know various types Understand the family may be overwhelmed.

Symptoms of End of Life Pain: Common. May be complex Respiratory: dyspnea, cough, wheeze GI: Nausea, constipation, aspiration Psychological: Depression, anxiety, hallucinations, delirium, decreased LOC Spiritual: Crisis of faith

Interventions Long acting + PRNs vs. PRNs (esp pain) Oxygen, inhaler vs. nebulizer, diuretics, steroids Anti-nausea meds, bowel stimulants vs. osmotic agents Anti-depressants, anxiolytics Non-pharmacologic therapies

Addressing Spiritual Needs Offer religious music, writings, or icons Arrange for spiritual leader visit Facilitate rituals Assist with funeral arrangements DO NOT WAIT UNTIL THE LAST MINUTE!!!!!!

Cultural Considerations Most people have more than one culture Manifested through values, beliefs, customs, and behaviors Affects decision making, views on death, & many other aspects of care Race, ethnicity, religion, and lifestyle contribute to culture

Preserving Dignity Cleanliness and oder control Bathing and grooming Mouth and nail care Clothing and bedding Maximize independence

The Final Hours Pain and noisy breathing Attending to symptoms and hygeine Limited food/fluid intake Maintaining personhood Talk to resident appropriately Educate family

Thank You! Any Questions?