Public lecture delivered at the Toowoomba Hospital by Dr Patty Lee-Apostol, 3 November 2016.

1. LIVING BETTER, DYING BETTER
PATTY LEE-APOSTOL, MD,FRACP,FACHPM
DARLINGDOWNS HEALTH DISTRICT

2. Outline of Talk
◦ What is palliative care?
◦ What are the core values of palliative care?
◦ Who should receive palliative care?
◦ When should palliative care be delivered?
◦ Are there any proven benefits for palliative care?
◦ How do we deliver palliative care in our district?
◦ What are the palliative care services available in Toowoomba?
◦ What is advance care planning?
◦ End of Life at home
◦ Links for further information

3. WHAT DOES PALLIATIVE
CARE MEAN TO YOU?

7. Palliative care
◦ Is an approach to care
◦ Is multidisciplinary
◦ Anticipates problems that might arise
◦ Aims to minimize the impact of the progressing, life-limiting
illness
◦ Goal is for maximum function and comfort within the limits
of the illness

8. Core Values of Palliative Care
◦ Maximize Quality of Life and relieve distressing symptoms

9. Core Values of Palliative Care
◦ Provides relief from pain and other distressing symptoms

11. Core Values of Palliative Care
◦ Affirms life and regards dying as a normal process
◦ Intends neither to hasten or postpone death

12. Core Values of Palliative Care
◦ Integrates the psychological, emotional, spiritual, and social
aspects of care for the patient, the family, carers

13. Core Values of Palliative Care
◦ Offers a support system to help patients live as actively as possible
◦ Support system to help family and carers cope during px’s illness and
after the patient’s death

14. Core Values of Palliative Care
◦ Team approach

15. Core Values of Palliative Care
◦ Avoids futile intervention
◦ Medical Futility
◦ interventions that are unlikely to
produce any significant benefit for
the patient

16. WHO SHOULD RECEIVE
PALLIATIVE CARE?

18. Who Should Receive Palliative Care?
◦ Patients with progressive disease leading to death
◦ End stage organ failure
◦ Progressive neurological conditions
◦ Advance cancer
◦ Can be of any age
◦ Can be jointly managed with other health care providers
◦ Especially with fatal illnesses with prolonged or uncertain life
expectancies
◦ (e.g Alzheimer’s Disease, Chronic Renal Failure)

19. WHEN SHOULD PALLIATIVE CARE
BE DELIVERED?

21. When should palliative care be
delivered?
◦ Diagnosing of a life threatening illness
◦ Transition from curative to palliative intent
◦ Deterioration
◦ Terminal stage
◦ Bereavement

23. ARE THERE ANY PROVEN
BENEFITS FOR PALLIATIVE CARE
REFERRALS?

24. Benefits of Palliative Care Are Proven
in Cancer
◦ Better quality of life (numerous studies)
◦ Better ability to cope with their disease - adaptive-coping strategies
◦ involves taking actions to make one’s life better, such as
accepting one’s diagnosis and the use of emotional help (Greer,
et al, ASCO 2016)
◦ Leads to care more consistent with patient preferences (Higginson,
et al, Cancer 2010)

25. More benefits of Palliative Care
◦ Patients likely to discuss end of life care preferences with their
health care team
◦ Carers have significantly less decline in their psychological, social,
and spiritual quality of life scores. (Meyers et al, 2011)
◦ Improved patient and carer’s satisfaction
◦ Reduce overall cost of care

26. More benefits of Palliative Care
◦ reduce aggressive end-of-life care and improve psychosocial
wellbeing among patients and families (Wright et al, JAMA 2008)
◦ people who understood the amount of time they had left to live
and the benefits and risks of treatment received less aggressive
end-of-life care but they lived longer (Smith et al, 2012)

27. Early Palliative Care in Metastatic Lung Cancer
◦ Randomized trial: standard cancer care with early
palliative care from diagnosis vs standard cancer
care only
◦ Improved quality of life
◦ Reduced major depression (16% vs 38%)
◦ Reduced aggressive end of life care (33% vs 54%)
◦ Better Survival (they lived longer) (11.6 months vs
8.9 months)
Temel et al NEJM
2010;363:733-742

28. ◦ Housebound terminally ill people with cancer who received in-
home palliative care as well as usual care reported
◦ greater satisfaction with care
◦ had fewer emergency room visits and hospital days
◦ had lower costs of care
◦ were also more likely to die at home
◦ Brumley et al, 2007

29. HOW DO WE DELIVER
PALLIATIVE CARE IN OUR
DISTRICT?

30. The Palliative Care Team in Darling
Downs Health District (Public)
◦ 1 Palliative Care Specialist Consultant
◦ 1 Palliative Care CNC
◦ 2 Palliative Care Outreach Nurses ( 1 Full Time and 1 Part Time Nurse)
◦ Allied Health Team (Physio, Occupational Therapy, Social Worker, Dietician, Speech
Pathology, Psychology)
◦ 1 Medical Registrar
◦ 1 Medical Resident
◦ Patient’s GP and Patient’s other Specialist (Oncologist, Respiratory Physician, etc)
◦ Domiciliary Nurses (Blue Care and Ozcare) and local Allied Health
◦ Rural Pall Care Nurses within the DIstrict

35. WHAT ARE THE PALLIATIVE
CARE SERVICES AVAILABLE
IN TOOWOOMBA?

36. In hospital

38. Community Palliative Care
At Home

39. In Hospice

40. In Residential Aged Care Facilities
(Nursing Homes)

41. Advance Care Planning

43. Key features of an Advance Care Plan
• Ongoing discussion
• Allows patient to express their wishes about their
future care
• Helps inform the clinical management plan and
enables care providers to advocate for patient
• Can be a legally binding document (e.g.
Advance Care Directive) or a more informal
document (Statement of Choice)
• Who is the substitute decision maker

45. End of Life Care at home
◦ “I want to die at home”
◦ There is help and support available
◦ Medical support
◦ GP’s
◦ Palliative care specialist
◦ Nursing Support
◦ Community Nurses
◦ Allied Health Support
◦ Carers and Familiy
◦ *Cannot emphasize benefits of
advance care planning

46. FOR THOSE WHO WANT
MORE INFORMATION…

47. Links and resources

49. THANK YOU 