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Palliative Care Are you worthy to serve the suffering?

Explore the importance and role of Palliative and Supportive Care in the life of cancer patients. Learn about the challenges, opportunities, and unique aspects of providing compassionate end-of-life care. Discover the collaborative efforts in Iowa to enhance palliative care awareness, education, and delivery statewide.

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Palliative Care Are you worthy to serve the suffering?

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  1. Palliative Care Are you worthy to serve the suffering? Timothy A. Thomsen M.D., Director Greg Hamilton J.D., Administrator UIHC Supportive and Palliative Care Program September 25, 2018

  2. What is Palliative Care?What is Supportive Care?Why?

  3. Objectives • 1. Understand the role and concept of Palliative Care. • 2. Understand the importance of Supportive Care in the life of a Cancer Patient. • 3. Explore the opportunities to meet the Supportive and Palliative care needs of all Iowans through education and collaboration. • 4. Lots of other really important stuff.

  4. The Deconstructed Patient:Virtually every patient in America.

  5. Being the Voice of the Patient inTHE BATTLE

  6. WHO definition Palliative Care…improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems: physical, psychosocial and spiritual.

  7. J.E. Luckey M.D.

  8. Delivery of Palliative Care:“Out of your scientific mind” death Curative or disease modifying palliative diagnosis Hospice

  9. UIHC Palliative Medicine Team • Advanced Practice Nurses • Physicians • Music Therapist • Social Worker • Chaplains • Pharmacists • Volunteers • Behavioral psychologist • RNs

  10. Palliative Care: Consultation • Pain and non pain symptom management • Goals of Care • Shared decision making • Family support • Hospice referral • “The family is unreasonable”

  11. Unique Challenges of Palliative Care Patients • Fear: yours and theirs (Death) • Deterioration • Multiple Pain Etiologies • Grief • Multiple Customers and expectations

  12. “I want to go home?”May the patient go home?Skilled Care vs. Hospice

  13. Mrs. Orte

  14. Ecstasy

  15. “To effectively support a patient and family, you must be able to manage your fear AND your feelings about serious illness and death.”

  16. The patient will do the dying perfectly.Preparation for death requires time.Empathetic, compassionate conversation does not take away hope.“Thank you for being honest with me.”

  17. Hospice Federal entitlement program Replaces Medicare Part A Offered by most insurance companies Medicaid

  18. Qualifications for Hospice • Six Month Life Expectancy • Medicare Enrollee or other Payer Program • No longer pursuing curative therapy for the Primary Hospice Diagnosis

  19. Supportive Care Empowered nurses who contribute to the early recognition of patients with life limiting illness or who are experiencing a mismatch between the goals of the patient/family and the goals of the healthcare providers.

  20. House File 393 May 2017 Directed the Iowa Department of Public Health’s Office of Health Care Transformation staff and the Patient-Centered Health Advisory Council to: Review and assess level of Palliative Care awareness in Iowa, as perceived by the public. Identify the barriers which prevent the early implementation of palliative care principles and recommend solutions.

  21. Palliative Care Awareness in Iowa A report from the IDPH’s Patient-Centered Health Advisory Council in response to House File 393 First of 14 Recommendations is to: Identify an organization that has expertise and is currently working in Palliative Care to coordinate stakeholders and Palliative Care efforts in Iowa. https://idph.iowa.gov/Portals/1/userfiles/71/Palliative%20Care%20Awareness%20in%20Iowa.pdf

  22. Preliminary discussions about how best to convene stakeholders IDPH’s Office of Health Care Transformation staff: Angela Doyle Scar Abby Less American Cancer Society Danielle Oswald-Thole Angie Sylling Shelley Walker

  23. Palliative Care Awareness in Iowa Report recommends Palliative Care stakeholders: Continue current work Promote education and awareness Conduct surveillance and assessment Define best practices Identify reimbursement methodologies Workforce development Utilize Advanced Care Planning

  24. Community-CenteredPalliative Care “Palliative Care Institute” Medical Director of Palliative Outreach Hubs of care Primary physician, pharmacy and nursing palliative care education Enhancement of interprofessional respect and collaboration Identify community capabilities i.e. primary care, hospital, hospice, pharmacy, emergency services

  25. Establish a collaborative model for palliative care delivery which is coordinated and supported by the major providers in the state.

  26. Summary The UIHC Supportive and Palliative Care program is comprehensive, collaborative and committed to helping to develop primary palliative capacity throughout the State of Iowa. Palliative Care (“The Art of Medicine”) must be available to all Iowans The State of Iowa and its citizens represent an ideal environment for statewide culture change which balances the highest level of medical science with the delivery of compassionate, humanistic care to every citizen.

  27. Inter-professional Supportive Care

  28. Summary • It is far easier to battle disease than to fight for your patient’s spirit. • Be willing to listen and learn, even when you are way outside your comfort zone. • Recognize the emotional and ethical tension that emerges at the end of life.

  29. Thank you Questions?

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