1. Caring, Curing and Comforting
September 13, 2018
Wendy Knowlton DO, HCMD
Jason Heffernan MD
Bonnie Blachly RN

2. Objectives Describe medicine’s shifts over the last 100 years
Myths about hospice and palliative care.
Why palliative care?
Comfort along the journey; describe models that integrate comfort before, during, and after curative therapy

3. “My dear, Americans are the only people who think death is an option.”
-- Barbara Walker
Leicester, England

4. How Americans Died in the Past
Early 1900s
Average life expectancy 47 years old
Only one person in 25 survived to age 60
Childhood mortality high

5. How Americans Died in the Past
Prior to antibiotics, people died quickly
infectious disease
accidents
Medicine focused on caring, comfort
Sick more often cared for at home

6. Medicine advances
Improved sanitation, public health, antibiotics, other new therapies
increasing life expectancy
2016 average 78.6 yrs
Drop from 78.7 yrs in 2015
Potential of medical therapies
“fight aggressively” against illness, death
prolong life at all cost

7. Medicine’s Shift in Focus
Science, technology, communication
Marked shift in values
“death denying” society
Death viewed as “the enemy”
Mortality rates are used to rank hospitals
Physicians have sense of failure if patient not “saved”
“Didn’t know it was this bad”; Mobility of Americans puts distance between many younger and older family members

8. End of Life Care in U.S. Today
Modern health care
only a few cures
live much longer with chronic illness
dying process also prolonged
To die of old age is a death rare, extraordinary, and singular a privilege rarely seen.
Montaigne, Of Age, 1575

9. Obstacles
Professional culture values saving lives through advanced technology more highly than compassionate care at end of life
Uncertainties in prognostication
Inadequate training of caregivers in palliative medicine
Fragmented, organ-oriented care

10. Everybody anticipating death deserves the option of hospice philosophy of care…
Everyone facing serious illness deserves the option of discussing their hopes and goals…

11. Myth #1 Hospice is only for patients who are actively dying.
Fact: Hospice is about maximizing the quality of a person’s life.
Many families and patients wish that hospice had been invited sooner due to increased comfort outside the hospital.

12. End of life Caregiving in the United States
A National Profile Of End-Of-Life Caregiving In The United States.
Article Link:
“Palliative care provides an added layer of support for seriously ill patients and their families, and it is available at any point in such an illness.”
“In contrast, hospice care is limited to the last months of life and may begin too late to fully benefit caregivers who have already experienced tremendous strain related to their caregiving”
- Kelley AS , Morrison RS . Palliative care for the seriously ill . N Engl J Med ; 373 ( 8 ): 747 – 55

13. Myth #2 Palliative care is the same as hospice.
Fact: Palliative care is a specialty, a support system for people with serious illness who may still be pursuing treatment and who have a life expectancy greater than six months.
All hospice care encompasses a palliative approach.

15. Myth #3 Palliative care means “giving up” and “dying”.
Fact: Mortality rate for anyone alive is 100%.
Palliative care is a team approach.
We talk about pros and cons of treatments
We talk about symptom management
We want help close gaps in understanding illness and treatment options with the goal of shared decision making
We will bring up when it is time to consider hospice

17. Which patient has a serious illness? Which patient is a hospice patient?

18. Comments and Questions
- Thank you!