Why we can't afford not to Katherine Sleeman

1. Transforming end of life care:
Why we can’t afford not to
Katherine Sleeman
NIHR Clinician Scientist and honorary consultant
King’s College London, Cicely Saunders Institute

5. Median age at death
0
10
20
30
40
50
60
70
80
90
women
men1861
1871
1881
1891
1901
1911
1921
1931
1941
1951
1961
1971
1981
1991
2001
2011
Year

6. Functional decline towards end of life
Function
100%
Time
19th C
21st C
0%

8. value =
quality
cost

10. “The experiences of people
who are dying and their loved
ones of the care provided
by the NHS is a recurring
theme in complaints.”

12. Early Palliative Care: RCT evidence
Bakitas,
2009. JAMA
Temel, 2012
NEJM
Zimmermann
,2014. Lancet
Higginson, 2015.
Lancet Resp
Bakitas,
2015. JCO
Quality of life + + + = =
Physical
symptoms
= n/a + + =
Depression + + n/a = =
Patient
satisfaction
n/a n/a + n/a n/a
Carer outcome = burden n/a + satisfaction
= QoL
n/a + depression
= QoL
Aggressiveness = + n/a n/a =

13. value =
quality
cost

14. Curative treatment Palliative
Care
DeathDiagnosis
Curative treatment
Diagnosis Death
Palliative Care

16. Early Palliative Care: RCT evidence
Bakitas,
2009
Temel, 2012
NEJM
Zimmerman,20
14. Lancet
Higginson, 2015.
Lancet Resp
Bakitas,
2015. JCO
Quality of life + + + = =
Physical
symptoms
= n/a + + =
Depression + + n/a = =
Patient
satisfaction
n/a n/a + n/a n/a
Carer outcome = burden n/a + satisfaction
= QoL
n/a + depression
= QoL
Aggressiveness = + n/a n/a =
Survival = + n/a + +

17. value =
quality
cost

22. Katherine.sleeman@kcl.ac.uk
@kesleeman
All references available at
https://wordpress.com/post/katherinesleeman.wordpress.com/