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End of Life

End of Life. at the. what every health professional should know about palliative care. Toby Campbell, MD MSCI. Objectives. What is palliative care? Communication strategies family meetings goals of care transitions difficult situations.

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End of Life

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  1. End of Life at the what every health professional should know about palliative care Toby Campbell, MD MSCI

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

  3. http://www.theonion.com/content/news/world_death_rate_holding_steady_athttp://www.theonion.com/content/news/world_death_rate_holding_steady_at

  4. Existential What is Palliative Care? Spiritual Social Psychological Physical

  5. OurCore Skills Care of the Dying Advanced Care Planning Complica-tions of Therapy Communi-cation Symptom Control • Psycho-social

  6. PM&R Internal Med Psychiatry OB/GYN ER Medicine Family Med Surgery Neurology Anesthesiology Radiology Pediatrics Multi-disciplinary specialty

  7. Survival Curve: Disease Normal Population % survival Disease Time

  8. Cure Normal Population % survival Cure Time

  9. LifeProlongation Normal Population % survival Prolongation of survival Time

  10. Palliative Care Normal Population % survival Palliative Care Time

  11. Intentions of Treatment Palliative Curative

  12. 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

  13. Modern Model Traditional Care Focus of Care Hospice Palliative Care Symptom Burden 6-Month Prognosis Death Diagnosis Time  Campbell TC et al Semin Intervent Radiol 2007

  14. Does Palliative CareMatter?

  15. Transfers to PCU

  16. Oncology Unit on the Oncology or Palliative Care?

  17. Other16% Lung26% GU15% GI26% Breast17% 84% “Big 4”

  18. 4.7 months 27% 1 year survival

  19. Difficult Conversations Oh No! A communication toolkit SPIKES NURSE I Wish Hope for the Best, Plan for the worst Outcome Oriented Make a Recommendation

  20. Setting the Scene

  21. Understand their Perception

  22. Get anInvitation

  23. Share Your Knowledge

  24. Silence

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

  26. Summarize Strategize

  27. Transitions in Care Tough Times Goals Transitions Heroes Denial

  28. Where are we going?

  29. 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

  30. Transitions in care Fix Knowledge barriers Orient to Outcomes Respond toEmotion

  31. The 11thHour Hero

  32. I want everything done

  33. Thank You Toby Campbell 608-206-9109 (m)

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