End of Life

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End of Life
at the

• what every health professional should know about
  palliative care

Toby Campbell, MD MSCI
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Objectives

• What is palliative care?
• Communication strategies
• family meetings
• goals of care
• transitions
• difficult situations

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http//www.theonion.com/content/news/world_death_r
ate_holding_steady_at
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Existential
What is Palliative Care?
Spiritual
Social
Psychological
Physical
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OurCore Skills
Care of the Dying
Advanced Care Planning
Complica-tions of Therapy
Communi-cation
Symptom Control
Psycho-social
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Multi-disciplinary specialty
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Survival Curve Disease
Normal Population
survival
Disease
Time
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Cure
Normal Population
survival
Cure
Time
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Life Prolongation
Normal Population
survival
Prolongation of survival
Time
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Palliative Care
Normal Population
survival
Palliative Care
Time
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Intentions of Treatment
Palliative
Curative
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Traditional Model of Cancer Care
Standard Cancer Care
Hospice
Bereavement
Bad News
Transitions to EOL
Emanuel LL, Ferris FD, von Gunten CF, Von Roenn
JH. EPEC-O Education in Palliative and
End-of-Life Care. Oncology, p. P2-7
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Modern Model
Traditional Care
Focus of Care
Hospice
Palliative Care
Death
6-Month Prognosis
Symptom Burden
Diagnosis
Time ?
Campbell TC et al Semin Intervent Radiol 2007
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Does Palliative Care Matter?
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Transfers to PCU
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Oncology Unit
on the

• Oncology or Palliative Care?

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84 Big 4
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4.7 months
27 1 year survival
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Difficult Conversations
Oh No!

• A communication toolkit
• SPIKES
• NURSE
• I Wish
• Hope for the Best, Plan for the worst
• Outcome Oriented
• Make a Recommendation

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Setting the Scene
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Understand their Perception
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Get an Invitation
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Share Your Knowledge
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Silence
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Empathic Statements

• NURSE
• Naming
• Understanding
• Respecting/Praising
• Supporting
• Exploring
• I Wish Statements

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Summarize
Strategize
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Transitions in Care
Tough Times

• Goals
• Transitions
• Heroes
• Denial

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Where are we going?
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Goal Setting

• Hope for the Best, Plan for the Worst
• Avoid the useless
• Do you want everything done for her?
• Should we restart her heart if it stops?
• Make a recommendation

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Transitions in care
Fix Knowledge barriers
Orient to Outcomes
Respond toEmotion
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The 11th Hour Hero
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I want everything done
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Thank You

• Toby Campbell
• 608-206-9109 (m)