Palliative Care - Dr. Bekanich


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Dr. Stephen Bekanich of Sylvester presented "Providing Quality of Life Care" at the 2011 WellBeingWell Conference in Miami.

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  • Do not offer what is not reasonably attainable
  • Palliative Care - Dr. Bekanich

    1. 1. Providing Quality of Life Care Well Being Well Conference April 26 th 2011
    2. 2. HEALTH CARE REPORT CARD <ul><li>People suffer from treatable symptoms </li></ul><ul><li>Patients and families are unsatisfied with our current system </li></ul><ul><li>Physicians often do not know or respect patients’ wishes in regards to serious illness </li></ul><ul><li>Traditional American medicine is disease-centered </li></ul><ul><li>Deficiencies in medical training are abundant for treating how the patient is feeling </li></ul><ul><li>Whole-patient care remains to be standardized </li></ul><ul><li>JAMA 1995; 274:1591-98 </li></ul>
    3. 3. PALLIATIVE CARE <ul><li>WHO Definition: </li></ul><ul><li>An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems; physical, psychosocial, and spiritual. </li></ul><ul><li>Which words are absent? Terminal, death, dying, hospice </li></ul>
    4. 4. EXPECTATION OF A PC SERVICE <ul><li>Evidence-based symptom management and psychological support by an interdisciplinary team </li></ul><ul><li>Shared decision making, patient advocacy, family and caregiver support </li></ul><ul><li>Treats patients and families with dignity and respects cultural values </li></ul><ul><li>Attends to practical, financial, and legal needs </li></ul><ul><li>Coordinates care across settings </li></ul>
    5. 5. The Old Model “ There is nothing more we can do” Life Prolonging Therapy Hospice Death Dx of life-threatening illness
    6. 6. The New Vision Life Prolonging Therapy Palliative Care for Patients and Families Hospice Bereavement Death Dx of life-threatening illness
    7. 7. CAREGIVERS
    8. 8. CAREGIVERS PROFILE <ul><li>Over 44 million </li></ul><ul><li>26 million spend over 18 hours/wk in this role </li></ul><ul><li>Cost equivalent ($8/hr) for uncompensated care is over $250 billion </li></ul><ul><li>Female, full-time, family, frail </li></ul><ul><li>Average length of caregiving is 4.3 years </li></ul>
    9. 9. FAMILY SATISFACTION WITH EOL CARE <ul><li>Not enough contact with MD 78% </li></ul><ul><li>Not enough emotional support 51% </li></ul><ul><li>Not enough information regarding 50% </li></ul><ul><li>dying process </li></ul>JAMA 2004; 291:88-93
    10. 10. NURSES HEALTH STUDY <ul><li>Prospective study of over 54,000 nurses </li></ul><ul><li>Increased rise of MI or death from cardiac causes (RR 1.8) if they cared for an ill spouse >9hrs/wk </li></ul>Am J Prev Med 2003; 24:113-19
    11. 11. Influence on the Health of Partners of Cancer Patients <ul><li>Data from Swedish Health Care Registry </li></ul><ul><li>Over 11,000 partners of patients with cancer followed without their knowledge </li></ul><ul><li>Health care use, cost of care, and diagnosis of the partners none evaluated before any after the time of the diagnosis of cancer in the patients </li></ul><ul><li>J Clin Oncol 2009; 27:1-7. </li></ul>
    12. 12. Sjovall, K. et al. J Clin Oncol; 27:4781-4786 2009 Fig 1. Health care costs (mean; Swedish kronor [SEK]) per month during a period of 4 years (24 months prediagnosis until 24 months postdiagnosis), partners of patients in all cancer groups
    13. 13. Sjovall, K. et al. J Clin Oncol; 27:4781-4786 2009 Fig A1. Psychiatric diagnoses in partners of patients with cancer (diagnosed 2000 to 2005) before and after the cancer diagnosis
    14. 14. WHAT CAN WE DO? <ul><li>Honor loved ones wishes </li></ul><ul><li>Include them in the process </li></ul><ul><li>Support in transitions </li></ul><ul><li>Honest, proactive information </li></ul><ul><li>24/7 access to providers </li></ul><ul><li>Listen </li></ul><ul><li>Practical help </li></ul><ul><li>Acknowledge changes in condition </li></ul><ul><li>Contact them regularly </li></ul><ul><li>Identify complicated grief </li></ul>
    15. 15. SPECIFIC COMMUNICATION COMPONENTS <ul><li>Quiet private place </li></ul><ul><li>Increased listening, decreased talking </li></ul><ul><li>Acknowledge and address emotions and non-verbal cues </li></ul><ul><li>Explore options </li></ul><ul><li>Establish advance directives </li></ul><ul><li>Affirm non-abandonment </li></ul><ul><li>Attend to the prevention and treatment of suffering </li></ul><ul><li>Provide explicit support for decisions </li></ul>Chest 2008; 133:775-786
    16. 16. “ Palliative Care Extends Life, Study Finds” <ul><li>151 Patients with Metastatic Non-Small Cell Lung Ca </li></ul><ul><li>Randomized to Early PC vs. Regular Care </li></ul><ul><li>Significant Increases/Improvements </li></ul><ul><ul><ul><li>Quality of Life Measures </li></ul></ul></ul><ul><ul><ul><li>Distressing Symptoms </li></ul></ul></ul><ul><ul><ul><li>Resource Utilization </li></ul></ul></ul><ul><ul><ul><li>Length of Life (2.7 Months) </li></ul></ul></ul>NEJM; 363; 733-42 New York Times, 08/27/2010
    17. 17. Helen Keller <ul><li>“ Although the world is full of suffering, it is also full of overcoming it.” </li></ul>
    18. 18. <ul><li>Contact Information: </li></ul><ul><li>Stephen J. Bekanich </li></ul><ul><li>[email_address] </li></ul><ul><li>305.439.4670 </li></ul><ul><li>Reading List: </li></ul><ul><li>Palliative Care, NEJM 2004; 350:2582-90 </li></ul><ul><li>Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians, Ann Intern Med . 2008; 148:141-146 </li></ul><ul><li>Meeting Physicians’ Responsibilities in Providing End-of-Life Care*, CHEST 2008; 133:775-786 </li></ul><ul><li>Seven Legal Barriers to End-of-Life Care, JAMA 2000; 284:2495-2501 </li></ul>