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What is a Good Death? by Ashley Shreves

Most patients with life-limiting illnesses prioritize quality over quantity of life. When faced with important medical decisions, these same patients would place a greater emphasis on likely outcomes of the treatments being considered than the burdens of the actual treatments.

Unfortunately, in our current system, health care providers do a poor job understanding the needs of these patients and often presume that a highly medicalized care plan is desired.

Conversations about the use of potentially life-sustaining treatment are done quickly and lack the critical components patients need to make informed decisions.

Through integration of palliative care principles into emergency medicine and critical care practice, providers can begin to re-align themselves with their patients and better understand how to get each patient the highest quality end-of-life experience.

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What is a Good Death? by Ashley Shreves

  1. 1. What is a good death? SMACC June 25, 2015 Ashley Shreves, MD Assistant Professor Department of Emergency Medicine Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mt. Sinai
  2. 2. Which looks like “good” dying?
  3. 3. What’s most important to patients facing death? Steinhauser JAMA 2000
  4. 4. Don’t patients want to live forever? n = 226 Advanced illnesses Fried N Engl J Med 2002
  5. 5. What’s most important? Non-medical >>> medical Quality of life >>> quantity of life Outcomes >>> treatments
  6. 6. Are we good with the non-medical? Teno JAMA 2005
  7. 7. Quality vs Quantity? Focused on resuscitation and life-prolongation Spectacular deaths: exciting and prioritized “Subtacular” deaths?? Care Poor Forgotten about Neglected Stuck in a corner and left there A lower class citizen in regards to EM Bailey Ann Emerg Med 2010
  8. 8. Outcomes? Time spent 1 min Content of conversation Descriptions of CPR Outcomes? Not mentioned
  9. 9. Want to do better?
  10. 10. Palliative Care Type of care Improve quality of life/relieve suffering Serious/advanced illness Multidisciplinary team approach Hospice System of care Improve quality of life/relieve suffering Terminal illness Multidisciplinary team approach
  11. 11. Mt. Sinai Palliative Care Team Doctor Nurse Practitione r Social Worker Chaplain Art therapist Massag e therapist Yoga therapis t Nurse Patient & Family
  12. 12. What do we do? COMMUNICATION COMMUNICATION COMMUNICATION
  13. 13. What happens? Medical decisions change Quality of life improves Symptom management improves Depression decreases Life often extended Costs decrease Volandes BMJ 2009 Temel N Engl J Med 2010 Teno JAMA 2004 Connor J Pain Symptom Manage 2007 Morrison Arch Int Med 2008
  14. 14. When is dying bad? WHEN IT’S ABOUT YOU
  15. 15. When is dying good? WHEN IT’S ABOUT THEM
  16. 16. How do patients get the good death? PALLIATIVE CARE & HOSPICE If not available LEARN COMMUNICATION SKILLS

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