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Palliative Care

Palliative Care. Focus on Suffering instead of pain. Bernard P Sweeney, MD Medical Director, Teresa House Geneseo , NY . Treatment Model . GOAL: Relieve suffering while maintaining quality of life . Physical symptoms Social Factors Emotional State

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Palliative Care

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  1. Palliative Care Focus on Suffering instead of pain Bernard P Sweeney, MD Medical Director, Teresa House Geneseo, NY

  2. Treatment Model GOAL: Relieve suffering while maintaining quality of life • Physical symptoms • Social Factors • Emotional State • Spiritual Status

  3. INTERDISCIPLINARY TEAM • Nurse • Chaplain • Physician • Social worker • Pharmacist • Home aide/volunteer

  4. PHYSICIAN • Control physical symptoms very quickly • Focus attention on patient exclusively • Simple language • Touch • Prognosticate • Family is integral

  5. NEJM August, 2010 (Temel et al) • 157 pts (107 completing) with metastatic non-small cell • lung cancer, 12 week study • Usual oncologic care vs Usual plus early palliative care • Primary outcome change in quality of life at 12 weeks • Measured by using following scales • FACT-L • Hospital Anxiety and Depression

  6. Results • Pts started on early palliative care: • Better quality of life ( using FACT-L scale) • 98 vs 91 • Pts started on early palliative care lived longer • 11.6 vs 8.9 months • Less depression 16% vs 38%

  7. CONCLUSION Significant improvements in quality of life and mood Lived longer

  8. CASE STUDY 78 y.o. old male with metastatic prostate cancer, diagnosed 3 yrs prior . Was admitted to Teresa house due to overall decline in physical status . Family unable to provide safe environment but willing to assist in care

  9. Admit meds from home included: Amitriptyline 100 mg poqhs Gabapentin 600 mg TID Motrin 800 mg TID MS Contin 60 mg TID MSIR 15 mg q 4 hrs prn breakthrough pain

  10. Physical Exam • Lethargic male who responded to verbal • command then quickly fell asleep again • Tender over lumbar and thoracic spine processes • Diffuse generalized weakness with flat Babinski bilaterally • No neurological focal defect

  11. CONCERNS • Initially meet with wife, daughter and Nurse director • Both understood terminal condition but ?? if his quality of Life could be improved • Could current meds be adjusted to limit lethargy Control suffering

  12. CARE PLAN • Devised in concert with Nurse director • Consultant pharmacist • Stopped amitripytyline • Added decadron 4 mg po bid • Weaned gabapentin to 900 mg poqhs • Continued MS Contin

  13. Continued • With med changes pt was very comfortable • Still lethargic and weak

  14. NEXT STEP • SLOWLY Transitioned Off morphine to methadone • Decrease Total daily dose of morphine by 1/3 • Start Methadone at to 2.5 mg potid • 2 Days later decrease morphine dose by another 1/3 • Increase methadone to 5 mg potid as comfort worsened • 2 days later MS Contin stopped Methadone increased to 10 mg BID

  15. Follow -Up • Within 7 weeks of admission to Teresa house • Patient was up ambulating, alert,having discussions • Was discharged to Home with spouse and daughter • Passed away peacefully 8 months later

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