Palliative Care Across the Continuum of Illness Jean Endryck, FNP-BC, ACHPN, NE-BC Director of Palliative Care St. Peter’s Health Partners/Seton Health Troy, New York July 23,

I, Jean Endryck, do not have any relevant financial interests or other relationships with a commercial entity producing healthcare-related products and/or services. 2

Learning Objectives Identify the principles of Palliative Care Understand how Palliative Care applies across the continuum of illness 3

OLD LANGUAGE Palliative care is the medical specialty focused on improving the quality of life of people facing serious illness. Emphasis is placed on pain and symptom management, communication and coordinated care. Palliative care is appropriate from the time of diagnosis and can be provided along with curative treatment. Source: 2011 Public Opinion Research on Palliative Care: CAPC 4

NEW YORK STATE LAW Palliative care, as defined by the law, is “health care treatment, including interdisciplinary end-of-life care, and consultation with patients and family members, to prevent or relieve pain and suffering and to enhance the patient’s quality of life, including hospice care” PHL §§2997-c and 2997-d 5

Palliative care is specialized medical care for people with serious illnesses. This type of care is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness – whatever the diagnosis. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of doctors, nurses, and other specialists who work with a patient’s other doctors to provide an extra layer of support. Palliative care is appropriate at any AGE and at any STAGE in a serious illness, and can be provided together with CURATIVE TREATMENT. Source: 2011 Public Opinion Research on Palliative Care by CAPC NEW LANGUAGE 6

7

NATIONAL CONSENSUS PROJECT Third Edition, 2013 Developed clinical practice guidelines for quality Palliative Care which are: 1.Define the essential elements of palliative care 2.Drive development and improvement in clinical programs 3.Help clinicians incorporate palliative care into routine practice 4.Promote quality, consistency and reliability of services 5.Foster access to palliative care across the continuum of health care services 8

NATIONAL CONSENSUS PROJECT DOMAIN 1: Structure and Processes of Care DOMAIN 2: Physical Aspects of Care DOMAIN 3: Psychological and Psychiatric Aspects DOMAIN 4: Social Aspects of Care 9

NATIONAL CONSENSUS PROJECT (continued) DOMAIN 5: Spiritual, Religious, and Existential Aspects of Care DOMAIN 6: Cultural Aspect of Care DOMAIN 7: Care of the Patient at the End-of-Life DOMAIN 8: Ethical and Legal Aspects of Care 10

NATIONAL QUALITY FORUM (NQF) 2012 report identified a framework and set of NQF endorsed™ preferred practices that focus on improving palliative care across the Institute of Medicine’s six dimensions of quality-safe, effective, timely, patient-centered, efficient, and equitable The preferred practices mark a crucial step in the standardization of palliative care and hospice There are 38 preferred practices Source: 11

12 PALLIATIVE CARE VS HOSPICE All of hospice is palliative care, but not all of Palliative care is hospice Palliative Care Hospice

ASCENSION HEALTH MODEL 13

The Joint Commission Advanced Certification Program for Palliative Care Started in 2011 Signifies that hospitals are committed to patient and family centered care Certification based on clinical practice guidelines through the National Quality Forum Consensus Report NQF has identified 38 preferred practices that focus on improving palliative care and hospice care across the IOM six dimensions of quality, safe, effective, timely, patient centered, efficient, and equitable 14

15 Chronic Disease Management Geriatrics Transitions Programs Readmissions Programs Palliative Care Modified from Diane Meier, MD CAPC CLINICAL INTERSECTIONS

CONTINUUM OF ILLNESS FACT: Approximately 90 million Americans live with at least one chronic disease. FACT: In New York City, the average person with a serious illness receives care from 12 specialists, with no one coordinating care Source: Dartmouth Atlas of Health Care 16

Continuum of Illness: Adult and Pediatric Hospital Palliative Care Teams: Emergency Department: IPAL-EM Intensive Care Units: IPAL-ICU Medical Floors Outpatient: IPAL-OP covering clinic, home based Assisted Living Homes Nursing Homes, Skilled Nursing Facilities 17

CONTINUUM OF ILLNESS Pulmonary Heart Failure Dementia Hepatic HIV/AIDS Neurological Diseases and Trauma Renal Cancer 18

EVIDENCE OF SUCCESS 2010 NEJM research study showed that patients with metastatic non-small cell lung cancer who received early palliative care along with standard treatment lived on average THREE MONTHS LONGER (11.6 months vs. 8.9 months) Pain and symptoms were well managed resulting in less admissions to the ED or inpatient Patients in the study experience less depression and improved QOL Chose less “aggressive” care at EOL Source: Temel, J.S., et.al. (2010). Early Palliative Care for Patients with Metastatic Non-Small cell lung cancer. NEJM(363),

CONCLUSION DON’T delay Palliative care for a patient with serious illness who has physical, psychological, social, or spiritual distress because they are pursuing disease directed treatment Numerous studies including randomized trials provide evidence that palliative care improves pain and symptom control, improves family satisfaction with care, and reduces costs Palliative care does not accelerate death and may prolong life in selected population Source: Five things Physicians and Patients should question in hospice and palliative medicine. Choosing Wisely; an initiative of the ABIM Foundation. Aahpm.org/choosingwisely 20

QUESTIONS? 21

RESOURCES Center to Advance Palliative Care: American Academy of Hospice and Palliative Medicine: Hospice and Palliative Nurses Association: National Consensus Project for Quality Palliative Care: National Quality Forum (NQF) Consensus Report:

RESOURCES Education in Palliative and End of Life Education: ELNEC: EPERC: Get Palliative care resource for families at

REFERENCES 2011 Public Opinion Research on Palliative Care accessed New York State Palliative care act accessed vecare/practitioners/resources.htm#prognosis National Consensus Project (NCP) Third Edition, 2013 accessed National Quality Forum (NQF) 2012 accessed

REFERENCES Dartmouth Atlas of Health Care accessed Temel, J.S., et.al.(2010). Early Palliative care for patients with metastatic non-small cell lung cancer. NEJM (363), Choosing wisely; an initiative of the ABIM Foundation accessed 25

26