1. The Patient/Family Value-Directed Model of Care
Section 1:
The Patient/Family Value-Directed Model of Care
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2. Changing Our Approach to Care From A Disease Focus to A Patient/Family Experience Focus
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3. Disease Focus Experience Focus
Patient/family identify their end-of-life goals
Assess how symptoms, issues are helping or hindering them from reaching goals
Interventions to reach end-of-life goals
Quality of Life Closure
Diagnosis of disease & related symptoms
Curing of disease focused goals
Treatment of disease & alleviation of symptoms
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4. Focus on the Experience !
Alleviation of suffering
Life Completion and Self-determined Life Closure
Bereavement Support for Survivors
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5. This model is built around three concepts or beliefs learned from caring for dying patients and their families:
 We live and die as multidimensional beings...having physical dimensions, spiritual dimensions, social/emotional dimensions.
 No dimension exists or functions alone....when one dimension changes, it affects other dimensions.
 When we pay attention to all dimensions and this dynamic relationship between them, we can then best affect quality of life closure for dying patients and their families.
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6. Patient-Family Value Directed Model of Care
Dying is a personal experience
People experience the last phase of life through many related dimensions
The last phase of life provides continued opportunity for positive growth & development in the face of suffering
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7. 1. Dying is a Personal Experience: Creating Quality EOL Experiences
Choice
Advocacy
Compassion
Dignity
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8. 2. People experience the last phase
2. People experience the last phase of life through many related dimensions
Five Dimensions
Symptom/Physical
Function
Interpersonal
Well-being (intrapersonal)
Transcendent/Spiritual
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9. No dimension exists or functions alone....
when one dimension changes, it effects other dimensions……
And quality of life closure
The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

10. What Affects Quality of Life Closure?
Interpersonal
Well-being
Transcendent
Dimensions Increase
In Importance
As Symptom &
Function
Dimensions
Decline
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11. How does an issue/problem/opportunity in one dimension affect others?
Anxiety affect physical state
Physical pain affect one’s ability to focus on communicating life closure
Spiritual fears affect readiness to die
Immobility affect ability to attend to spiritual needs
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12. Mr. Carey, a patient with cancer of the bone has suffered a pathological fracture of his right arm....Physical dimension
Due to this pain, he is confined to his bed unable to fully bathe and toilet independently....Function dimension
Because any movement is difficult - he is no longer able to leave his room and is isolated from family and friends.....Interpersonal dimension
As a result he begins questioning “Why is this happening to me?”, “What did I do to deserve this?”….Spiritual dimension
He is feeling depressed and guilty because he can’t be self sufficient....Well-being dimension
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13. How is this affecting his family - wife?
His wife can’t stand watching his suffering.....feeling helpless to change it.....asking God, “Why are you allowing him to suffer?”....Spiritual dimension
Since he can no longer care for himself independently she is doing all his personal care and is becoming exhausted....Physical dimension
She is no longer able to rationalize his angry outbursts and lashes back at him....Interpersonal dimension
When she does stop to think about his suffering, she feels guilty for lashing out and feels like she is so inadequate. How could she blame him?....Well-being dimension
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14. How does an issue/problem/opportunity for growth affect the patient/family quality of life closure?
Physical pain (physical).
This not allowing the patient to get out of bed (functional).
This is preventing him from joining family members in the other rooms for meals, TV viewing, visits (interpersonal).
He is becoming isolated and lonely (well-being).
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15. Patient has guilt over past “sins” (spiritual).
How does an issue/problem/opportunity for growth affect the patient/family quality of life closure?
Patient has guilt over past “sins” (spiritual).
He is refusing any pain medications because he feels he needs to suffer to have a place in heaven (physical).
His pain is so severe that he is angry at anyone trying to help him (interpersonal).
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16. The Last Phase of Life Provides Continued Opportunity for Positive Growth in the Face of Suffering
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17. Life Closure: A Personal Experience
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18. Completion with Worldly Affairs
Sense of completion with worldly affairs –
These begin with the parts of a person’s life that are furthest out from themselves.
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19. Completion with Worldly Affairs Completion of Community Relationships
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20. Completion with Worldly Affairs Completion of Community Relationships
Meaning About One's Individual Life
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21. Completion with Worldly Affairs Completion of Community Relationships
Meaning About One's Individual Life
Love of Self
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22. Completion with Worldly Affairs Completion of Community Relationships
Meaning About One's Individual Life
Love of Others
Love of Self
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23. Completion in Family/Friends Relationships
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24. Completion in Family/Friends Relationships
Acceptance of the Finality of Life
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25. Completion in Family/Friends Relationships
New Self Beyond Personal Loss
Acceptance of the Finality of Life
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26. Completion in Family/Friends Relationships
Meaning About Life in General
New Self Beyond Personal Loss
Acceptance of the Finality of Life
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27. Surrender to Unknown “Letting Go”
Completion in Family/Friends Relationships
Meaning About Life in General
New Self Beyond Personal Loss
Acceptance of the Finality of Life
Surrender
to Unknown
“Letting Go”
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