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Palliative Therapy: Before and at End of life

Palliative Therapy: Before and at End of life. Phil Watson, D.O., F.A.C.O.I., F.A.C.C., F.A.C.C.P. DISCLOSURES: I have nothing to disclose. Objectives. Discuss the Existence of the Sub-Specialty Palliative Therapy Before and at the End of Life

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Palliative Therapy: Before and at End of life

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  1. Palliative Therapy: Before and at End of life Phil Watson, D.O., F.A.C.O.I., F.A.C.C., F.A.C.C.P.

  2. DISCLOSURES: I have nothing to disclose.

  3. Objectives • Discuss the Existence of the Sub-Specialty Palliative Therapy Before and at the End of Life • Explain POLST – Physician Orders for Life-Sustaining Therapy

  4. How Americans Die: A Century of Change Frequent

  5. DJDJD

  6. I

  7. Our Constitution upholds the right to life, liberty and the pursuit of happiness Deathisnotthere

  8. Public Perception

  9. POLITICS

  10. HR 3200, Section 1233 Intent was to get people NOT critically ill to think about and choose the treatment they would want at end of life Provision would allow health care providers to receive payment from Medicare for counseling with patients on end of life issues Supported by AMA, AOA, AARP, National Hospice and Palliative Care Organization

  11. Critical Dimensions of Humanistic Care • Competence • Medical, palliative care • Ethical • Cultural • Communication skills • Empathic imagination • Self –awareness • Healing • Partnership • Nonabandonment

  12. Five Critical Elements of Medical Partnerships Sharing power and expertise Mutually influencing and understanding one another Clarifying commonness and differences Negotiating differences Ultimately patient-centered

  13. Clarifying Commonness and Differences: Potential Dimensions of Conflict Diagnosis and prognosis Goals of treatment Goal in life Methods of treatment Conditions of treatment Relationship Psychological and emotional factors Spirituality and religion

  14. Negotiation of Differences Listen and learn about each other’s position Separate the person from the problem Invent solutions of mutual gain Call in a third party Take a “time-out” Give in on nonessential areas Explore the likely effects of each choice Know your bottom line

  15. Initial Steps in Delivering Bad News Greet and calibrate Find out how much the patient knows Find out how much the patient wants to know Share information tailored to the individual Respond to the patient’s feelings Make a plan and follow through

  16. Desired Outcomes of Early Meetings • Minimize aloneness and isolation • Achieve a common perception of the problem • Address basic information needs • Address immediate medical risks, including risk of suicide • Respond to immediate discomforts • Ensure a basic plan for follow-up • Anticipate what has not been talked about

  17. Coping Responses to Bad News CATEGORYEXAMPLES Basic psychophysiologic Fight-flight Conservation-withdrawal Cognitive Denial Disbelief Blame Acceptance Intellectualization Affective Anger Shame Fear Relief Anxiety Guilt Helplessness Hopelessness

  18. Clinical Indications for Discussing Palliative Care ABSOLUTE INDICATIONS Patients fear future suffering Patients or family members ask about hospice Patients are imminently dying Patients talk about wanting to die Severe suffering and a poor prognosis POTENTIAL INDICATIONS WITH SEVERELY ILL PTS When discussing the patient’s hopes and fears When discussing prognosis Would you be surprised if the patient died in the next 24 months?

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