Your SlideShare is downloading. ×
Prolonged dying phase handouts march 2012
Prolonged dying phase handouts march 2012
Prolonged dying phase handouts march 2012
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Prolonged dying phase handouts march 2012

633

Published on

Presented

Presented

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
633
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
7
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Prolonged Dying Phase is licensed under aCreative Commons Attribution-ShareAlike 3.0 Unported License Christian Sinclair, MD, FAAHPM – ctsinclair@gmail.com @ctsinclair March 2012 - AAHPM Annual AssemblySlides available on Slideshare before during and after the conference http://www.slideshare.net/ctsinclairDisclosures: noneObjectives: Describe the challenge of prolonged dying from the perspective of patient and family Understand the difference between objective and subjective measurements of time and prognosis Describe how the perspective of time and prognosis influences suffering at the end of lifeWorking definition:Prolonged dying phase is identified when the dying process ofa terminal patient with minimal functionexceedsthe expected or true prognosisto the degree whichthe patient, family or health care teambegins to questionthe expected time frame.Physical symptoms and physical sufferingdo not need to be present for PDP,yetsuffering related to time and expectationsmay be experienced by all involved.Aspects of PDP • Patient is terminally ill • Care setting and tenor reflects terminal status • PPS ≤ 30% • May be identified by patient, family or staff • Usually acceptance; even welcoming of death • Suffering dependent on perception of time/ meaning as opposed to physical symptomsWhat PDP is not… • “We’re all dying…” – Denial/minimizing coping mechanisms • Lack of consensus of impending death • Not from first declaration of terminality/diagnosis • Not a side effect of medically hastened deaths • Depression Subjective vs. Objective PDP SUBJECTIVE OBJECTIVE • Prognosis dependent • Stochastic (random) – Errant prediction • Medical interventions • Communicated • Failed external outcome • Formulated • Organ transplant • Perceived • Special event – Multiple predictor (wide range) • Statistical deviation – Altered time passage • Prognosis independent – Stochastic (random) – Labeling – Acceptance – “Time bind” hypothesis – Altered time passage
  • 2. Time bind hypothesis (Hothschild 1997) – The fast pace of our lives makes us less patient with indefiniteor extended periods of timeUniversity of Wisconsin Donation after Cardiac Death Evaluation Tool (2003)

×