1. Palliative Care Education Module

2. Objectives Understand the definition of Palliative Care.
Recognize the difference between hospice and palliative care
Recognize patients that are appropriate for palliative care consultation

3. Hospice Care and Palliative Care
There is a relationship between hospice and palliative care, but they are not same thing.

4. Hospice Care and Palliative Care
Hospice – focus is on care, not cure, and on the quality and value of life, not duration.
Hospice emphasizes the use of palliative care.
Typically occurs at end of life.
Palliative Care – goal is to prevent and relieve suffering and support best possible quality of life for patients and their families, regardless of the stage of the disease or need for other therapies.
May be provided at any time, along with curative or life-prolonging treatment.

5. Hospice Care Patients with a prognosis of ≤ 6 months
Focus changes from Curing to Caring
Attempts to cure or delay the progression of the disease will stop
Comfort Care is always provided
Focus on Quality of Life
Covered by Medicare Part A benefit
Interdisciplinary care provided by a Medicare Certified Hospice Provider

6. Palliative Care Specialized, interdisciplinary care
Aims to relieve suffering and improve quality of life for patients with advanced illness and their families.
Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount.
It is offered simultaneously with all other appropriate medical treatment.
Should be provided throughout the patient’s medical treatment experience

7. What about Pain Management?
Pain is the single most common reason individuals seek medical care
Pain Management can be part of Palliative Care
However, not every patient receiving pain management services is identified as a palliative care patient
Consider the goals of your patient’s care (cure vs. care)
Consider the cause of the pain (ex. cancer, physical injury, etc.)
How far advanced is the patient’s disease process?
What is patient’s quality of life?
Does my patient need both pain management and palliative care?
Goal: control pain well enough to enhance quality of life

8. And Comfort Care?
Comfort care is an essential part of medical care at the end of life
Goal: prevent or relieve suffering as much as possible while providing for a “good” death
It sounds like palliative care, but it is different
Palliative Care may be provided at any time along with curative or life-prolonging treatment.
While Comfort Care is reserved for end of life (or dying) care.

9. It’s confusing because quite often these different services are provided by the same team of practitioners.
Remember!
It’s never too early to initiate the conversation regarding patient wishes regarding care

10. Conceptual Shift of Care Goals
Curative Care Model
Integrative Model of Care

11. Categories of illness appropriate for Palliative Care Services
These are examples, not an all-inclusive list
Pancreatic, Esophageal or Stomach Cancer
Brain Cancer
Lung Cancer
Peritoneal Cancer
Secondary Malignant Neoplasms
Cystic Fibrosis and ventilator support or oxygen dependence
COPD and ventilator support or Oxygen Dependence
Heart Failure
ESRD
Dementia
Stroke
Parkinson’s
ALS
Any end-stage disease

12. Triggers for Patient Referrals
Patient with advanced long term condition or new diagnosis of a serious illness or both?
Would you be surprised if this patient died within the next year?
Does the patient:
Have decreased function
Live in a nursing home
Progressive weight loss
Assisted living
≥ 2 unplanned admits in past 12 months
Need more personal care at home
Similar to EPIC
Does this patient have advanced cancer or heart, lung, kidney, liver or cognitive failure?

13. Provider Expectations
Document care appropriately
What are the goals for your patient? How far along is the disease process?
Pain management, palliative care or both?
The patient may require multiple types of care or services.
Palliative Care is appropriate at any stage of illness.
Hospice is targeted to end of life (≤ 6 months).
Patient typically goes home with Hospice care or is transferred to Inpatient Hospice
Comfort Care is part of the medical care provided at end of life.
The patient may or may not be transitioned to Hospice.
Often seen in the hospital.

14. Case Study #1
60 year old male with stage 4 non-small cell carcinoma [adenocarcinoma] of possible pancreaticobiliary origin with progressive pulmonary metastatic disease who is hospitalized with progressive respiratory distress leading to intubation and mechanical ventilation. He has chronic and poorly controlled pain and anxiety.

15. Case Study #1 Is he appropriate for hospice?
Would he benefit from a Palliative Care Referral?
Answer:
His survival is likely to be less than 6 months making him eligible for hospice services.
He has uncontrolled symptoms and no clear goals of care that are realistic and appropriate to his situation making him an appropriate palliative care referral.

16. Case Study #2
77 year old male with advanced combined Heart Failure with Atrial Fibrillation, ischemic cardiomyopathy and severe Mitral Regurgitation. Ejection Fraction 25%. His goal is to try short term rehabilitation and return home. He would want to return to the hospital for any acute symptoms.

17. Case Study #2 Is he appropriate for hospice?
Is he appropriate for palliative care?
Answer:
He does have an advanced medical condition that is likely approaching end stage, however, he wishes to pursue active treatment including hospitalization and predicting a 6 month prognosis is difficult. He is not appropriate for hospice.
He does have an advanced medical condition that is life limiting and will likely cause him to be symptomatic and he would be appropriate for palliative care referral.

18. Case Study #3
98 year old female hospitalized with moderate dementia, moderate COPD, hypertension, CKD III, UTI and mild confusion. She lives independently in a Continuous Care Community in her own apartment and is capable of managing her own ADL’s. She has an advance directive and a POLST. After 2 days of antibiotic therapy she is less confused, ambulating with assist of 1 and feeding herself.

19. Case Study #3 Is She appropriate for hospice?
Is She appropriate for palliative care?
Answer:
She does not have an end stage medical condition and does not have a prognosis of 6 months or less. She is not eligible for hospice.
She has no uncontrolled symptoms, she has documented advance directives with clear wishes and goals of care. She is not appropriate for a palliative care consult.