What is a good death?SMACC

June 25, 2015

Ashley Shreves, MDAssistant Professor

Department of Emergency MedicineBrookdale Department of Geriatrics and Palliative Medicine

Icahn School of Medicine at Mt. Sinai

Which looks like “good” dying?

What’s most important to patients facing death?

Steinhauser JAMA 2000

Don’t patients want to live forever?

n = 226Advanced illnesses

Fried N Engl J Med 2002

What’s most important?

Non-medical >>> medical

Quality of life >>> quantity of life

Outcomes >>> treatments

Are we good with the non-medical?

Teno JAMA 2005

Quality vs Quantity?Focused on resuscitation and life-prolongation

Spectacular deaths: exciting and prioritized

“Subtacular” deaths??

Care Poor Forgotten

about

Neglected

Stuck in a corner and left there

A lower class citizen in regards to

EM

Bailey Ann Emerg Med 2010

Outcomes?Time spent

1 min

Content of conversationDescriptions of CPR

Outcomes?Not mentioned

Want to do better?

Palliative Care

Type of care

Improve quality of life/relieve suffering

Serious/advanced illness

Multidisciplinary team approach

Hospice

System of care

Improve quality of life/relieve suffering

Terminal illness

Multidisciplinary team approach

Mt. Sinai Palliative Care TeamDoctor

Nurse Practition

er

Social Worke

rChaplain

Art therapi

st

Massage

therapist

Yoga therapi

st

Nurse

Patient &

Family

What do we do?

COMMUNICATION

COMMUNICATION

COMMUNICATION

What happens?Medical decisions changeQuality of life improvesSymptom management improvesDepression decreasesLife often extended

Costs decrease

Volandes BMJ 2009Temel N Engl J Med 2010

Teno JAMA 2004Connor J Pain Symptom Manage 2007

Morrison Arch Int Med 2008

When is dying bad?

WHEN IT’S ABOUT YOU

When is dying good?

WHEN IT’S ABOUT THEM

How do patients get the good death?

PALLIATIVE CARE & HOSPICE

If not available

LEARN COMMUNICATION SKILLS