This document discusses the need for more widespread palliative care. It notes that many patients currently receive poor end-of-life care in hospitals, with conversations about goals and prognosis often lacking or brief. While palliative care specialists could help, there is a severe shortage. The document argues that the solution is to train all clinicians, through fellowships, courses and online resources, to better address palliative care needs themselves since there will never be enough specialists to meet demand. All medical professionals must be prepared to provide palliative care.

1. We Need Palliative Care
Everywhere
SMACC DUB 2016
Ashley Shreves, MD
Dept of Emergency Medicine
Ochsner Medical Center
New Orleans, LA

2. Case
• 2009
• EMS: 93 y/o f, resp distress
• HR 25, BP 90/50, O2 sat 90%, RR 35

4. What happened next...

5. Specific challenges
• Identify dying trajectory
• Capacity assessment
• Advance directives
• Difficult communication
• Withholding/withdrawing LST
• EOL symptom management
• Spiritual competency
• Ethics
• Systems of care

6. Maybe it’s just me

7. Conversations bad, brief or nonexistant
Dying patients “neglected;” staff
uncomfortable
Dying in hospital:
less respect, quality of care worse

8. WE ALL SUCK AT THIS

9. Relevant to you?
Canada: 1/3 cancer patients visit ED last 2
wks of life
Australia: 65% patients w serious illness
die in hospital/ED

10. WE ALL SEE THESE PATIENTS

11. WHAT SHOULD WE DO?

12. Consult Palliative Care?
• Sure, but…
• 67% US hospitals (50+ beds) have pal care
• Workforce shortage: have 3K, need 18K (just in hospital)
• There will never be enough
Lupe D et al. J Pain Symptom Manage 2010
Dumanovsky T et al. J Palliate Med 2016
Kamal AH et al. Ann Intern Med 2015

13. Solution?

15. Fellowship

16. Mid-career courses

17. Online resources

18. We need palliative care everywhere