1. Overview of Palliative Care Suzann Bonzo, MD

2. The Greatest Barrier  The greatest barrier to end of life care is Clinicians  Due to the lack of confidence in their ability to talk about EOL issues and poor delivery of “bad news”

3. End of Life  The last 18 months of life often encompass the longest and most frequent hospitalizations and the most cost.  During the last 18 months of life, studies show that patients and families desire to stay home with less aggressive interventions.

4. Today  Today is to help us:  Understand why Palliative Care originated  Be able to discuss the benefits of Palliative Care  Be aware of barriers to Palliative Care  Understand challenges of Palliative Care

5. Palliative Care in Hospice  Initially Hospice and Palliative Care were essentially the same  Need to think of a continuum of care  Longer period of time  Many life limiting diseases  End of life is not clearly defined

7. Components of High Quality Palliative Care  Pain will be adequately treated  Avoid inappropriate prolongation of life  Obtain a sense of control  Relieving burden  Strengthen relationships with loved ones

8. National Consensus Project  Quality Palliative Care developed guidelines  Structure and process of care  Physical aspects  Psychological and psychiatric aspects  Social aspects  Spiritual, religious, and existential aspects  Cultural aspects  Care of the imminently dying patient  Ethical and legal aspects

9. Preferred Practices for Palliative and Hospice Care  Handout

10. Make up of the Palliative Care Team  The National Consensus Project for Quality Palliative Care recommends that the interdisciplinary palliative care team include palliative care professionals with the appropriate patient- population- specific education, credentialing, and experience and ability to meet the physical, psychological, social, and spiritual needs of both patient and family.

11. Referrals from PCP to Hospice  PCP works directly with Interdisciplinary team of RN, SW, Counselors  Manage symptoms and medications  Certification for PC/ Hospice  Sign death certificates

12. Palliative Care Involves:  Trust  Overcoming barriers to care and symptom relief  Compassionate communication  Accurate prognostic information  Maintaining hope  Eliciting symptoms  Decisions regarding curative and palliative treatments  Dealing with varying emotions  Educating when unrealistic goals are being sought

13. Most Common Diagnoses

15. Benefits of Palliative Care at the End of Life  Quality of life  Satisfaction with care  End of life outcome  Family and care-giver perceptions of end of life care  Survival advantage (especially in CHF)  Cost-effectiveness

16. Challenges in Palliative Care  Lack of trained professionals  Reimbursement issues  Difficulty in prognosis  Knowledge and attitude of patients, families, and healthcare providers

17. Comparison: Palliative Care and Hospice  Handout

18. Admission Criteria  Handout  Palliative Care Appropriate Screening Tool

19. Communication in the End of Life Setting  One of the most important skills for providers:  Disease process  Prognosis  Likely symptoms and how they will be managed  Treatment options and effect on quality of life and length of life  Answer difficult questions regarding the dying process  Advance care planning

20. Timing of Palliative Care Discussion  Earlier than later