1. End of Life what every health professional should know about palliative care at the Toby Campbell, MD MSCI

2. Objectives What is palliative care? Communication strategies –family meetings –goals of care –transitions –difficult situations

3. http://www.theonion.com/content/news/world_death_rate_holding_steady_at

4. Physical Spiritual Social Existential Psychological What is Palliative Care?

5. Communi- cation Advanced Care Planning Complica- tions of Therapy Psycho- social Care of the Dying Symptom Control Our Core Skills

6. OB/GYN Pediatrics Neurology Psychiatry Radiology Surgery PM&R ER Medicine Anesthesiology Family Med Internal Med Multi- disciplinary specialty

7. Survival Curve: Disease Normal Population Disease % survival Time

8. Cure Normal Population % survival Time Cure

9. Life Prolongation Normal Population % survival Time Prolongation of survival

10. Palliative Care Normal Population Palliative Care % survival Time

11. Intentions of Treatment Palliative Curative

12. Traditional Model of Cancer Care Hospice Standard Cancer Care Bad NewsTransitions to EOL *Emanuel LL, Ferris FD, von Gunten CF, Von Roenn JH. EPEC-O: Education in Palliative and End-of-Life Care. Oncology, p. P2-7 Bereav ement

13. Modern Model Traditional Care Palliative Care Hosp ice Death6-Month Prognosis Diagnosis Focus of Care Time  Symptom Burden Campbell TC et al Semin Intervent Radiol 2007

14. Does Palliative Care Matter?

15. Transfers to PCU

17. Oncology Unit Oncology or Palliative Care? on the

18. Lung 26% GI 26% Breast 17% Other 16% GU 15% 84% “Big 4”

20. 4.7 months 27% 1 year survival

23. Difficult Conversations Oh No! A communication toolkit SPIKES NURSE I Wish Hope for the Best, Plan for the worst Outcome Oriented Make a Recommendation

24. Setting the Scene

25. Understand their Perception

26. Get an Invitation

27. Share Your Knowledge

28. Silence

29. Empathic Statements NURSE –Naming –Understanding –Respecting/Praising –Supporting –Exploring I Wish Statements

30. Summarize Strategize

31. Transitions in Care Goals Transitions Heroes Denial Tough Times

32. Where are we going?

33. Goal Setting Hope for the Best, Plan for the Worst Avoid the useless: –“Do you want everything done for her?” –“Should we restart her heart if it stops?” Make a recommendation

34. Transitions in care Fix Knowledge barriers Orient to Outcomes Respond to Emotion

35. The 11 th Hour Hero

36. I want everything done

37. Thank You Toby Campbell 608-206-9109 (m)