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Palliative Care are we ready? ,[object Object],[object Object]

Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What is Palliative Care? ,[object Object],[object Object]

What is Palliative Care? ,[object Object],[object Object],[object Object],[object Object]

NEJM article: if a pill could do what palliative care can do… ,[object Object],[object Object],[object Object],[object Object],151 patients with metastatic non-small cell lung cancer Standard oncologic care Early Palliative care + standard oncologic care

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NEJM article: if a pill could do what palliative care can do… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Palliative Care Extends Life, Study Finds ,[object Object],[object Object],[object Object],[object Object]

“ It’s not about killing Granny; it’s about keeping Granny alive as long as possible — with the best quality of life.” - Diane Meier, NYTimes

Early End-Of-Life Care Helps Lung Cancer Patients Live Longer ,[object Object],[object Object],[object Object],[object Object],[object Object]

Do we want to supersize healthcare?

More medical care ≠ better medical care ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Relationship between cost of care and quality of death in the final week of life (adjusted P= 0.006) Zhang, B. et al. Arch Intern Med 2009;169:480-488.

Associations Between Caregiver’s Outcomes and Patients’ End-of-Life Care and Quality of Life (N=202) Copyright restrictions may apply. Wright, A. A. et al. JAMA 2008;300:1665-1673.

Relationship Between Quality of Life and End-of-Life Care Copyright restrictions may apply. Wright, A. A. et al. JAMA 2008;300:1665-1673.

So is Palliative Care then about rationing? ,[object Object],[object Object],[object Object]

So what could palliative care do for you? Resolve conflict: clinician-patient ,[object Object],[object Object],[object Object]

Clinician-patient/family conflict Futility • Autonomy • Non-maleficence Withholding • Withdrawing IHI: Underuse • Misuse • Overuse Clinician Patient Life Death Everything Nothing Care Abandonment Cure Comfort Hope Despair

Clinician-patient/family conflict ,[object Object]

Palliative care can help address psychological distress among surviving family ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

What could palliative care do for you? Assist with coordination of care across care-settings ,[object Object],[object Object],Palliative care team arranged hospice services in Virginia Beach, after weekend home to pack and prepare for trip. Identified accepting physician. Bed, meds, etc. arranged for his arrival.

What could palliative care do for you? Not just for cancer care: Assist with coordination of care across care-settings ,[object Object],[object Object],[object Object],Discussion held with patient & family: discharge home with hospice. No hospitalizations over the following 6 months. Patient remains alive and still meets hospice criteria.

Art Buchwald quoted by Richard Severo, NYTimes – Jan 19, 2007 ,[object Object]

What could palliative care do for you? Assist with coordination of care across care-settings ,[object Object],[object Object],[object Object],Barbera, L., Taylor, C., & Dudgeon, D. (2010). Canadian Medical Association Journal DOI: 10.1503/cmaj.091187

What could palliative care do for you? Assist with complex symptom management ,[object Object],[object Object],[object Object],[object Object]

Optimal care for patients ,[object Object],[object Object],[object Object]

We will do everything. The question is, what kind of everything?

Palliative Care at HealthAlliance Hospital Why? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],UMass: Recognizes that growing palliative care is imperative for improvement of quality care in current economic condition

Palliative Care at HealthAlliance Hospital How? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Palliative Care at HealthAlliance Hospital: Opportunities for Collaboration with UMass ,[object Object],[object Object],[object Object],[object Object]

Palliative Care at HealthAlliance Hospital: Opportunities for Collaboration with UMass ,[object Object],[object Object],[object Object],[object Object],[object Object]

Palliative Care at HealthAlliance Hospital How? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Regular interdisciplinary/transdisciplinary team meetings Collaboration with ethics, case management

Thank you ,[object Object],[object Object]

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